STUDENT’S NAME: _______________________________________________ ID #: _________________
Instructions to instructor:
This form is to be completed by the instructor of the challenged/waived
class. The instructor must sign the form in order for the student to receive
credit or have the requirement waived.
This student (choose one):
Passed a waiver examination
Earned challenge credit by examination
Student received a grade on the challenge exam of _________ for _________ hours of credit
Did not pass the waiver/challenge exam
COURSE CODE: ____________________________
COURSE TITLE: _______________________________________________________________________
________________________________ _______________________________________ ____________
Instructor’s Name Instructor’s Signature Date