03/21/17
Los Medanos College
Adult Education Course Completion and Grade
Verification Form for Credit by Examination
Articulation with Los Medanos College
LMC Student ID#
___________________
__________________________________________________________________________________________________________
Part I – Student Information/Courses Requested
Name ___________________________________________________ Date of Birth _________/_________/__________
Last First
Phone ___________________________________ Email Address ___________________________________________
Please list the LMC Course Number and Title that appear on the Articulation Agreement:
LMC Office Use Only:_________________________________________________________________________________________
Processed By:__________________________________________________
Date: ____________________________________
Course Number
Course Title
Units
By signing below, I acknowledge that I am or was previously enrolled in the High School course that is listed in the formal articulation
agreement between my Adult Education Center and Los Medanos College.
My signature indicates understanding that upon completion of the final examination and/or articulation agreement requirements, a grade of A, B,
CR/NC will be recorded on the transcript with a notation of "credit by exam" indicating college credit was granted by examination. Grades below B will
not be recorded.
Adult Ed. Student Signature: ____________________________________
Date: _________________________________
__________________________________________________________________________________________________________
Part II – High School Authorization - To be filled out by High School teacher at completion of course and final
examination.
Please list the Adult Education Center Name, Adult Ed. Course Title and Date of final examination that appear
on the Articulation Agreement:
Student credit posted to A&R: _____________________________________
I certify that the student named above has completed the above named adult ed. course and final examination and/or articulation
agreement requirements which I administered on the above date, and has received the following grade on the final examination
and/or articulation agreement requirements:
Grade on Final Exam: (Check one)
Name of teacher/examiner (please print): ________________________________________________________________________
_________________________________________________________________________________________________________
Teacher/Examiner Signature Date
A
B
Adult Education Center:
Adult Ed. Course Title:
Date of Final Exam
