Fillable NOTE: If credit is granted, it will appear (North Georgia Technical College)

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NOTE: If credit is granted, it will appear (North Georgia Technical College)

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Application for Exemption Credit
Print clearly or type.
NOTE: If credit is granted, it will appear on your Academic History as Transfer Credit with a grade of “EX.” Exemption credit is not used to
calculate GPA but does satisfy graduation requirements.. Exemption credit is not typically transferrable to other institutions. You may not
take an exemption test if you are enrolled in the course, if you have previously been enrolled in the course, or if you have previously
attempted the exemption test
APPLICATION PROCEDURE: (A separate application is required for each exemption test)
1. Complete the top section of this application before registering for any course you plan to exempt (No later than the last day of drop/add).
2. Contact an instructor within the appropriate department to schedule the exemption test (Instructor will insert date, time, and location).
3. Take this application to the cashier’s office and pay non-refundable exemption test fee (Cashier will attach payment confirmation).
4. Submit this application (With top three sections completed) to instructor on the date of the exemption test.
1. Student Completes this Section: Submit to Instructor designated to administer the exemption test.
Date:
NGTC Student ID #:
Name:
Last
First
Middle or Maiden
Mailing Address:
City:
Zip:
Phone:
( )
Course # and Title:
Credit Hours:
For Example:
COMP 1000, Introduction to Computers
Credit Hours:
3
2. Instructor Completes this Section (Before Test): Enter exemption test schedule and return form to the STUDENT.
Exemption Test Schedule:
Date:
Time:
AM PM
Exemption Test Location:
Building:
Room:
3. Cashier Completes this Section: Staple payment receipt to this form and present to instructor at the time of the exemption test.
The non-refundable fee for an exemption test is 25% of the course tuition.
Total Credit Hours for Course
Exemption Test Fee
Date Paid:
X $100.00 = Course Tuition X 25%
= Business Office Staff Member Receiving Payment:
4. Instructor Completes this Section (After Test): Submit signed, completed form to the Registrar’s office.
I certify that this student
has
has not
met the criteria for exemption of the listed course.
Test Score:
Instructor’s Signature:
Date:
As set forth in the student catalog, North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age,
political affiliation or belief, genetic information, disabled veteran, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). For
complaints or information, contact Mike King, VP of Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500
HWY 197 N, Clarkesville, GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint
Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of
the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence
Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. 7/16/19
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NOTE: If credit is granted, it will appear (North Georgia Technical College)

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Completed 25 July 2020

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