ENROLLMENT SERVICES
COLLEGE LEVEL PROGRAM (CLEP)
Date
BHC ID Name
Currently Enrolled: [ ] Yes [ ] No
List only the scores which meet the minimum requirements:
NAME OF EXAM BHC COURSE Score Credits
/
/
/
/
BURSAR’S OFFICE USE
Amount Paid $ ($10 per course) Date
Signature ________
AUTHORIZATION TO POST TO ACADEMIC RECORD UPON PAYMENT OF FEES
Registrar’s Signature Date
Entered on Academic Record by (Initials) Date
O:Enrollment Services\Forms\CLEP_FORM (Revised 8/22/14)