TENNESSEE TECHNOLOGICAL UNIVERSITY
Cookeville, TN 38505
APPLICATION FOR CREDIT BY SPECIAL EXAMINATION
Date
1. STUDENT FILLS OUT THIS SECTION:
TO THE ADMISSIONS AND CREDITS COMMITTEE:
I hereby make application for special examination in the following subject:
Sem. Hrs.
Disc. Course No. Title of Course Credit
BASIS FOR REQUEST:
My request is based upon the following experience or training: (Use back if necessary)
Student ID Number Student Signature
2. FACULTY ADVISOR:
I recommend that the request be granted.
Date Advisor’s Signature
3. DEPARTMENTAL CHAIRPERSON IN WHICH THE COURSE IS OFFERED:
I recommend that the request be granted and that be authorized to give the examination.
(INSTRUCTOR’S NAME)
Date Chairperson’s signature
4. RECORDS OFFICE AUTHORIZATION:
(Instructor) , you are hereby authorized to give the applicant the examination described above, provided
he/she presents you a receipt from the Business Office for the fee of $20.00 per semester hour. Submit to my office (1) this
application and authorization form, and (2) the receipt for the fee. Submit to your departmental chairperson’s office (1) the
examination questions, and (2) the applicant’s answers to the questions.
Date: Signed:
(Asst. Director of Records & Registration)
5. TEST ADMINISTRATOR SEND EXAMINATION AND ANSWERS TO DEPARTMENTAL CHAIRPERSON:
I have reviewed the examination and the applicant’s answers and placed them on file in my office.
Date Dept. Chairperson’s signature
6. COURSE INSTRUCTOR SENDS GRADE REPORT TO OFFICE OF RECORDS:
I have given to (applicant) the examination authorized above, and I have submitted the necessary
papers to the proper offices.
Sem. Hrs
Disc. Course No. Title of Course Credit Grade
Date of Exam: Course Instructor’s Signature
