Request for Credit by Examination

Request for Credit by Examination
*The cost will be $25/per credit hour plus any course or testing fees applicable.
Name*

First NameLast Name
Student ID*
Student's Email*

Confirmation Emailexample@example.com
Phone Number
Please enter a valid phone number.
Course Discipline
Course*
Example: ENGL 1010
Course Title
Example: English Composition
Credit Hours*
Signature*

Clear
By signing and submitting this form, you acknowledge that your electronic signature is the is the legally binding equivalent to your handwritten signature. By submitting this form, you hereby request an examination to earn credit for the above-mentioned course.
Date*

MonthDayYear
Date
Dept Head/Coordinator Approval
Dept Head/Coordinator's Email*
example@example.com
Should be Empty:

Dept Head/Coordinator Approval