Augusta Technical College
Application for Credit by Institutional Exemption Exam
STEP 1: Obtain approval from Student Records. Approval will not be granted for a course you have
attempted.
Printed Name: ____________________________Student ID/SSN: __________________
(Last First Middle)
Program of Study: _______________________________Phone: ____________________
Request Exemption for:
Course Number Title Credit Hours Fee
______________ ______________________________ ________ ________
Note to Student: I understand that the credit hours and grade will not be computed in my grade point average and
may not be transferable. A grade of “EXE” however, will be placed on my transcript for successfully exempting the
course. I am also aware that exemption may affect my financial aid status, and the exemption exam fees are not
refundable after completing the exam.
Student’s Signature: ______________________________ Date: _____________________
Approval: _______________________________________ Date: ______________________
(Registrar or Assistant Registrar)
STEP 2: Departmental Approval (Dean: ______________________, Building:___________ )
Dean’s Approval: __________________________ Date: ________________________
Designated Examiner: ______________________ Date: ________________________
(Note: The student must pay appropriate fees before the exam is administered.)
STEP 3: Payment Verification (Student Accounts Office, Building: 100 )
Student Accounts: _______________________ Date: _______________________
(After Student Accounts designee signs, the student presents the form to the designated examiner.
STEP 4: Present this form on your scheduled exam date. You will be taking the exam during
the final exam period.
Examiner Name Printed: _____________________ Location: __________________
Exam Results: The examiner is to record the results of the exam and submit form to the Dean. The Dean will
forward the form to the PLA Coordinator. DO NOT SEND FORM BY THE STUDENT.
Passed with an “A” (90% - 100%) ______ Passed with a “C” (75% - 79%)________
Passed with a “B” (80% - 89%) _______ Failed (below 75%) ______
Examiner’s Signature: ______________________ Date: _______________________
Qualified students are allowed one exemption attempt per course.
Consult the appropriate academic dean regarding available exemption exams.
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