Evaluation Worksheet for Certificate		Emergency Medical Technician (EMT-1) Refresher
SID:	________________________________	Skills Certificate - 5019
		Effective: Fall 2022
		Public Safety
Name:	________________________________	(707) 836-2921

REQUIREMENTS: Complete 0.5 units Emergency Medical Technician (EMT-1) Refresher Course Requirements - complete 0.5 units Course Description Units Completed In Progress Comments EMC 104.1  Emergency Medical Technician Refresher 0.5

	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: ____________________________________________