Office of the Registrar
Credit by Examination
Instructions
Last Name
First Name
M.I.
Date
Street
E-mail
City
County
State
Zip
SID(V00-00-0000)
Student Level
Course in which you wish to be examined:
Prefix Number
Credits
Qualifications:
A. Previously taken coursework at another institution which you believe duplicates the course named above. List the course title and the name of the school(s) where the course was taken.
B. List by title and author, text books used in the above course(s).
C. Work experience related to the course in which you wish to be examined.
D. Published materials you have used which you feel are pertinent.
E. Independent study you have pursued which you believe qualifies
you to be examined in the course above.
Application Accepted:
Application Denied:
Dept. Chair's Signature
Date
Date and time for examination:
$25.00 (per credit hr) Examination fee paid prior to examination:
Candidate
has
successfully passed:
Candidate
has not
successfully passed:
Examiner's signature
Examiner's signature
Examiner's signature
Dept./Division Chair's signature
Registrar's Approval: