Evaluation Worksheet for Certificate Advanced Cardiac Life Support
SID: ________________________________ Skills Certificate - 5022
  Effective: Fall 1981
  Public Safety
Name: ________________________________ (707) 524-1731

REQUIREMENTS: Complete 0.5 units

Advanced Cardiac Life Support Requirements - complete 0.5 units
CourseDescriptionUnitsCompletedIn ProgressComments
HLC 275C Advanced Cardiac Life Support1.0   

    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



Date: ________________________   By: ____________________________________________