Evaluation Worksheet for Certificate		Emergency Medical Technician (EMT-1) Refresher
SID:	________________________________	Skills Certificate - 5019
		Effective: Fall 2014
		Public Safety
Name:	________________________________	(707) 836-2921

REQUIREMENTS: Complete 1.0 units Emergency Medical Technician (EMT-1) Refresher Course Requirements - complete 1.0 units Course Description Units Completed In Progress Comments EMC 104.1  Emergency Medical Technician Basic - Refresher 1.0

	Evaluation worksheet completed upon receipt of Transfer Credit Evaluation form. Includes credit from other institutions only received to date.
	Evaluation worksheet completed for ________________________________. Includes all SRJC and transfer credit received to date.

Units completed:    __________ Units in progress:    __________ Total:    __________

Requirements Completed     Pending (work in progress)     Requirements Not Completed

Comments

Date: ________________________   By: ____________________________________________