Fillable Credit-by-exam-application - APP FOR CRED BY EX

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Credit-by-exam-application - APP FOR CRED BY EX

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U.S.A. forms for Mohawk Valley Community College

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!!1101!Sherman!Drive,!Utica,!NY!13501!
!!!!!!!!!!!!!!!!Phone!(315)!792=5336!
!!!!!!!!!!!!!!!!!!Fax!(315)!792=5698!
!!!!!!!!!!!!!!!!!!!!!!www.mvcc.edu!
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Mohawk Valley Community College grants college credit by examination only to enrolled matriculated
students. Please refer to the complete policy for details.
Student Name _________________________ M# _________________________
Permanent Home Address _______________________________________________________
_______________________________________________________
Home Phone _________________________ Personal Email _________________________
Business Address ______________________________________________________________
______________________________________________________________
Daytime Phone _________________________ Business Email _________________________
I wish to receive credit for Course #: _________ Title: __________________ Credit: __________
Academic Center ________________________ Degree/Certificate Program ________________
I have read the Credit by Examination policy and I confirm that:
• I am a matriculated student and currently enrolled in a program at MVCC
• I have not taken this course previously at MVCC
• The course is offered in the current MVCC catalog and is either required or an elective in my current
program
• I have not yet completed 75% or more of the credits required in my program
_______________________________________________________________________________
Student Signature Today’s Date
Please submit this form to the Associate or Assistant Dean of your Academic Center
OFFICE USE ONLY
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Rec eived!By/Date!_ ___________________!
!
APPLICATION FOR
CREDIT BY EXAMINATION
!
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!1101!Sherman!Drive,!Utica,!NY!13501!
!!!!!!!!!!!!!!!!Phone!(315)!792=5336!
!!!!!!!!!!!!!!!!!!Fax!(315)!792=5698!
!!!!!!!!!!!!!!!!!!!!!!www.mvcc.edu!
STEP 1: To Be Completed by the Academic Center in Which Student is Matriculated
This course will apply to the matriculated major:
Course # __________________ Title _____________________________________ Credit _______________
How will the course apply? ☐Major Course ☐Elective ☐General Education Course
Notes ___________________________________________________________________________________
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature (Major) Center Date
STEP 2: To Be Completed by the Academic Center in which the Course is Housed
Course # __________________ Title _____________________________________ Credit _______________
Assigned Faculty Mentor _____________________________________
Notes ___________________________________________________________________________________
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
STEP 3: To Be Completed by the Faculty Mentor (Initial Plan)
I have received the Credit by Examination Application and the student has agreed to complete this plan by
__________________.
(Due Date)
Comments _______________________________________________________________________________
________________________________________________________________________________________
Faculty Mentor Signature Date
STEP 4: To Be Completed by the Business Office
Course # __________________ Title_____________________________________ Credit _______________
Paid Amount _______
________________________________________________________________________________________
Business Office Verification Date
APPLICATION FOR
CREDIT BY EXAMINATION
!
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3!
1101!Sherman!Drive,!Utica,!NY!13501!
!!!!!!!!!!!!!!!!Phone!(315)!792=5336!
!!!!!!!!!!!!!!!!!!Fax!(315)!792=5698!
!!!!!!!!!!!!!!!!!!!!!!www.mvcc.edu!
STEP 5: To Be Completed by the Faculty Mentor (Examination Results)
I have completed the credit by examination review. The result is: ☐Pass ☐Fail
Comments _______________________________________________________________________________
________________________________________________________________________________________
Faculty Mentor Signature Date
STEP 6: To Be Completed by the Academic Center in which the Course is Housed
I acknowledge receipt of faculty work and award _______ credit hours for _____________________________.
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
STEP 7: To Be Completed by the Academic Center in which Student is Matriculated
I acknowledge receipt of notification of credit awarded (or denied).
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
Please return this completed form to
Rosemary Spetka, Registrar, PH 140.
OFFICE OF RECORDS AND REGISTRATION
USE ONLY
!
Rec eived!By/Date!_ ___________________!
Posted!By/Date!____________________!
Major!Cent er!Notified/Date!____________________!
Student!Notified/Date!____________________!
!
APPLICATION FOR
CREDIT BY EXAMINATION
!
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Completed 9 February 2020

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