White Records and Registration Yellow Department Pink - Student REG 05/15
Credit for Prior Learning
Students should contact the appropriate academic department for specific information on obtaining credit for prior learning
Credit for prior learning will be determined by a departmental evaluation of the type, content and rigor which will be determined
by each academic department
This form should be filled out completely and brought to the academic department
Once credit is to be awarded, the academic department will forward this form to the Records and Registration Office
Please Print:
Last Name ___________________________________First Name ____________________________________
CCM ID # ____________________ Major _______________________________________
I am requesting credit for prior learning through (check one):
Professional and/or Job Related Experiences
Non Collegiate Military Training Military Transcript is required
Non Collegiate Corporate Training Courses Training Certificate is required
I am requesting credit for the following CCM course(s):
Course Id
Title
Credits
Approved
Dept.Chair
Initials
Ex: BUS 101
Intro to Bus
3
Student Signature _______________________________________________________________ Date _____________
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Department Approval
If any or all courses were denied approval please state reason: _____________________________________________________
_________________________________________________________________________________________________________
For approved courses, please provide evidence supporting prior learning alignment with current CCM course objectives:
________________________________________________________________________________________________
_________________________________________________________________________________________________
Department Chair Signature ________________________________________Date___________________________
***Department Chair please return this form to Records and Registration so credits can be awarded***
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Records and Registration
Rec and Reg Input _______________ Date __________________________
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