Revised 08/2017
Office of the Registrar / 200 West Kawili St. Hilo, HI 96720-4091 / Student Services Center, First Floor Rm 101 / Phone: (808) 932-7447 / Fax: (808) 932-7448 / E-mail: uhhro@hawaii.edu
CREDIT BY INSTITUTIONAL EXAMINATION
• A student is eligible for Credit By Institutional Exam during the Fall and Spring semesters under the “Credit By Institutional
Exam” policy provided he/she is currently enrolled in one of the UH Hilo colleges & pays the appropriate fee(s).
• Each course that a student wishes to challenge requires a separate form and $15 fee per course.
• Credit By Institutional Exam may not be administered to a student for courses in which credit was already issued.
• Native or bilingual speakers of a foreign language may not receive credit for courses in that language.
• Form can be submitted after the 5
th
week of instruction.
• Credit By Institutional Exam results are processed by the Office of the Registrar after the 5
th
week of instruction.
• Credit(s) awarded for Credit By Institutional Exam is determined by instructor administering and scoring exam results.
SECTION I: Student Information and Department Chair Approval
Name: Student ID:
Last First MI
Phone: _____________________________________________ Email: _____________________________________________ @hawaii.edu
Semester: Fall Spring Summer Year: 20______
Course to be examined in: Course Alpha: ____________________________ Course Number: __________________________
Student signature: __________ Date: ___________________________
Instructor assigned to administer exam: ______________________________________ Email: _______________________________ @hawaii.edu
Department Chairperson name (print): _______________________________________ Email: _______________________________ @hawaii.edu
Department Chairperson Signature: ___________________________________________________ Date: ___________________________
SECTION II: Payment submitted and processed at the UH Hilo Cashier’s Office by published deadline and prior to exam
Paid Collected By: ________________________________ Date: _______________________________
Section III: Instructor Approval of Exam
I, (Print) ___________________________________________________________ will prepare & administer the examination on:
(Date) _________________________________(Time)_____________________________(Place)__________________________________________
Section IV: Instructor Approval of Credit By Institutional Exam Results*
*After the examination has been taken, INSTUCTOR submits completed form to the Office of the Registrar by published deadline. Form accepted by instructor only
Student earned grade of:_____________
Award _________ credits
NO credits awarded
Instructor’s Signature: _________________________________________________________________ Date: _______________________
SECTION V: For Office of the Registrar Use
SSASECT SECTION: 777 Grade Mode: M SFAREGS SFASLST SHAINST Initials: ______ Date: ____________
Voice
Response
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
