Admissions and Records
CREDIT BY EXAM PETITION
Page 1 of 1; Credit by Exam Petition Created: 6/13/2017; Rev: 6/13/2017
TMCC is an EEO/AA institution. See http://eeo.tmcc.edu for more information.
Instructions: Prior to completing this petition, please read the exam procedures and review the current courses eligible
for credit by exam. Applicant should submit this completed, signed form with payment to Admissions and Records.
Today's Date
NSHE ID
Date of Birth (mm/dd/yyyy)
Last Name
First Name
Middle Initial
Former Name (if any)
Telephone Number
Preferred Days/Dates/Times for Examination To Be Taken
Days/Dates
Times
Class For Which Exam Is Being Requested
Department (Ex: ENG)
Course (Ex: 101)
Credits (Ex: 3)
I am petitioning TMCC to allow me to obtain Credit by Examination for the above course. I understand that credits earned by exam may not
transfer to other colleges and universities.
Signature Date
FOR OFFICE USE ONLY
Admissions and Records - Initial
Form submitted to Admissions and Records
Admissions and Records has reviewed/processed/signed form and submitted to Accounting Services and applicable department
Rec'd by Date
Account Numbers
Registrar's Signature (or designee) Date Approved
Department/Grading Instructor
Department has contacted student to schedule exam
Exam has been given; grading instructor has signed and submitted to dean
Place of Exam
Date of Exam
Proctor
Grading Instructor's Signature Date
Grading Basis: Satisfactory Unsatisfactory
Dean
Dean has reviewed/processed/signed and returned form to Admissions and Records
Dean's Approval Signature Date
Admissions and Records - Final
Added to student's transcript Academic Year: Fall Spring Summer
Unsatisfactory grade not posted to transcript
Processed by Date
Instructions
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