C:\Users\newburgh\Desktop\Application for Proficiency.docx 7-18-13
APPLICATION FOR PROFICIENCY CREDIT
PROFICIENCY SERVICES ARE AVAILABLE TO STUDENTS WHO ARE CURRENTLY ENROLLED OR HAVE EARNED COLLEGE CREDIT AT
BLACK HAWK COLLEGE. PROFICIENCY CREDIT IS TREATED AS UNGRADED CREDIT EARNED.
Student Name: Student ID:
Step 1 – List the course for which you intend to seek proficiency. Use the course descriptions found in the Black Hawk College
catalog to assist you in completing this step. Use a separate form for each course. Additional forms are available from
Name of Evaluator (to be entered by Dept. Chair)
Step 2 – Make an appointment with the Department Chairperson. The Enrollment Services Office can help you determine
which Department Chairperson you should meet with. If the decision is made for you to continue the process, the
Department Chairperson will approve the courses and identify the instructor (in the space above) who will serve as
Department Chairperson Signature: Date
Step 3 – Take this form to the Bursar’s Office. Fees must be paid before meeting with the evaluator(s). Fees are:
$10.00 Per semester hour tuition (non-refundable)
$ 1.00 Per course recording fee (refundable). This is the only fee that is refundable.
For each course that is not passed, there will be a refund of $1.00.
Special Fees (non-refundable) will be assessed for certain courses. These charges will be identified when
meeting with the Department Chairperson.
For Bursar’s Office Use Only
Bursar’s Office Signature: __ Date
Step 4 – Take this form to the evaluator listed and make arrangements with them to seek proficiency of the course.
Step 5 – The evaluator will send the completed form to the Registrar. The Registrar will notify you as to whether you passed or
failed, and post passing credit. If credit is not awarded, the Registrar will initiate the appropriate refund. See Step 3
regarding the refund policy.
EVALUATOR: Do not interview the student or administer proficiency tests until the student has paid fees as indicated by the
Bursar’s Office. After completing the proficiency process, send this form to the Registrar. DO NOT GIVE THIS FORM TO THE
STUDENT AFTER THE PROFICIENCY HAS BEEN ATTEMPTED.
I have administered a proficiency examination for the course listed above and have indicated the results below.
Pass ____ Fail _____ Evaluator’s Signature: Date
REGISTRAR OFFICE USE ONLY