Institutional Exemption Exam Request
For students with previous knowledge and skill acquired through experience or other means, credit may be obtained for
certain specified courses by demonstrating mastery of the subject through written and/or performance exams.
A student may receive course credit by passing an institutional exemption exam.
The following conditions govern credit by exemption exam:
Student may not be currently enrolled or in or withdrawn from the class for which exemption is attempted
An exemption exam can be taken only once
No more than 23 semester credit hours may be earned by institutional credit exam
Payment of applicable exemption exam fee must be made prior to taking the exemption exam
(25% of course tuition). Charges for the exam are nonrefundable and are not covered by financial aid
Step 1. Registrar Approval: Complete Section A and submit to Registrar’s Office for course approval/signature.
Step 2. Dean Approval: Submit approved form to appropriate Dean for approval/exam scheduling – Section B.
Step 3. Payment: Submit form to College Store/Cashier for payment of fee prior to exam date – Section C.
Step 4. Exam: Submit form to Examiner. Examiner will submit form to Registrar’s Office with results of exam – Section D.
Section A: Registrar Approval
Student Name: Student ID/SSN:
Program of Study (Major):
Course for institutional exam credit: Credit hours:
Registrar/Asst. Registrar
Time:
Section B. Dean Approval and Scheduling
Institutional Exemption Examiner:
Campus/Room
Exam date:
Dean Signature
Section C. Payment of fees Cashier/College Store:
Cashier/College Store: If approved by Registrar and Dean, please process charge of $25.00 per credit hour.
(See above for course credit hours.)
Received by:
Receipt #:
Section D: Institutional Exemption Exam
Examiner: Check the appropriate statement and return to Registrar’s Office.
The above named student has successfully completed the examination and is qualified to receive credit by examination.
The above named student did not successfully complete the examination and is not qualified for credit by examination.
Examiner
Registrar/Asst. Registrar
click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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