Section 3: To be completed by student
Pay the non-refundable fee to Hawk Central and attach receipt to this form.
Section 4: To be completed by department lead and division dean
1. Coordinate the date/time for the Course Challenge with the student.
2. Upon completion of the Course Challenge, complete this section.
3. Faculty/department lead must submit form to division dean for signature. DO NOT return the form to the
student for processing.
CBC Course ID Satised Credits Approved Evaluation Methodology
q
q
q
I certify the student has passed the course challenge examination and authorize ________ credits be posted on
the transcript with a decimal grade of __________________.
__________________________________________________ ___________________________
Faculty/Dept. Lead Signature Date
__________________________________________________ ___________________________
Division Dean Signature Date
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the ba-
sis of race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or mil-
itary status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employ-
ment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are encouraged to participate in all college
sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
Section 5: To be completed by Student Records
Submit completed and approved form to:
Student Records
Mail Stop: H4
Course ID Credits Approved
q
q
q
__________________________________________________ ___________________________
Registrar Signature Date
We are temporarily accepting this form via email while our campuses operate remotely.
Deans, please submit the completed form and documentation to Janet Garza via email.
click to sign
signature
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signature
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