Fillable HS Artic Gr Verif EFill 2018 Term: (circle one)

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HS Artic Gr Verif EFill 2018 Term: (circle one)

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06/20/18
Los Medanos College
High School/ROP Course Completion and Grade
Verification Form for Credit by Examination
Articulation with Los Medanos College
LMC Student ID#
___________________
__________________________________________________________________________________________________________
Part I – Student Information/Courses Requested
Name ___________________________________________________ Date of Birth _________/_________/__________
Last First
Phone ___________________________________ Email Address ___________________________________________
Please list the LMC Course Number and Title that appear on the Articulation Agreement:
LMC Office Use Only:_________________________________________________________________________________________
Processed By:__________________________________________________
Date: ____________________________________
Course Number
Course Title
Units
By signing below, I acknowledge that I am or was previously enrolled in the High School course that is listed in the formal articulation
agreement between my High School and Los Medanos College. I also acknowledge that I have not attempted and examination in this
course previously.
My signature indicates understanding that upon completion of the exam procedure a grade of A, B, or P (Pass) will be recorded on the transcript with
a notation of "credit by exam" indicating college credit was granted by examination. Grades below B will not be recorded.
High School Student Signature: ____________________________________
Date: _________________________________
__________________________________________________________________________________________________________
Part II – High School Authorization - To be filled out by High School teacher at completion of course and final
examination.
Please list the High School, High School Course Title and Date of final examination that appear on the
Articulation Agreement:
Student credit posted to A&R: _____________________________________
I certify that the student named above has completed the above named high school course and final examination procedure, which I
administered on the above date, and has received the following grade on the final examination procedure:
Grade on Final Exam: (Check one)
Name of teacher/examiner (please print): ________________________________________________________________________
_________________________________________________________________________________________________________
Teacher/Examiner Signature Date
A
B
High School
High School Course Title
Date of Final Exam
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HS Artic Gr Verif EFill 2018 Term: (circle one)

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Completed 2 March 2020

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