Revised 09/16
COLLEGE OF THE SISKIYOUS
800 College Avenue, Weed CA 96094 * Fax: 530-938-5367 * registration@siskiyous.edu
APPLICATION FOR COLLEGE CREDIT BY COURSE CHALLENGE
Name: _________________________________________ Birthdate: __________ SID: S00___________________
Last First MI
Phone: _________________________ Email __________________________________________________
Address: ________________________________________________________________________________________
Street City State Zip
______ Units Completed at COS (Must have completed at least 12 units)
______ Grade Point Average at COS (Must have 2.0 or better cumulative GPA at COS.)
Course to be challenged: (Course must be listed in current catalog.)
Course No. ______________ Course Name _____________________________ Units ______________
Describe your experience or background that indicates a probability of success by course challenge.
Student Signature: ________________________________________ Date: _______________
1. Verification of eligibility for credit by course challenge: Eligible Ineligible
___________________________________________ ______________
Advisor or Counselor Date
2. Review by appropriate Dean: Approve Disapprove
Instructor Assigned: ________________________________________________
___________________________________________ ______________
Dean Date
3. Review by Instruction Council: Approve Disapprove
___________________________________________ ___________
Vice President –Instruction Date
4. Payment of fees to the Business office: Receipt #__________________ Date________________
5. Date of Completion: ____________ Grade: ______________
6. Date Instructor forward results to Registrar ________________________ Date grade posted on transcript ______________________
7. Business Office pays instructor: Date: ___________________ Receipt No.: _____________