Fillable PETITION FOR EQUIVALENCY EXAMINATION (Florida Institute of Technology)

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PETITION FOR EQUIVALENCY EXAMINATION (Florida Institute of Technology)

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PETITION FOR EQUIVALENCY EXAMINATION
Students must get verication from the Transfer Credit Evaluation area of the Oce of the Registrar (Registration Center) before having the form signed and
returned to the registrar’s oce. If the student presents substantiating evidence he/she may petition the appropriate academic unit head for permission
to take an equivalency examination to obtain credit for a course. Equivalency examinations may not be taken for any course for which a prior placement or
equivalency examination was evaluated; in which student received a grade, including a W or AU (audit); or a course in which student is enrolled beyond the
rst week of classes. Students may not take an equivalency examination during the semester in which they have petitioned to graduate. Equivalency
examinations are not available for graduate-level courses. No request for equivalency examination will be given until the appropriate fees are paid.
NAME ____________________________________________________________________________________________________________________ DATE __________________________________________________
Last First Middle
STUDENT ID NO. _______________________________________________  MAJOR ____________________  LOCAL PHONE NO. __________________________________________________________________
MAILING ADDRESS __________________________________________________________________________________________________________________________________________________________________
Street/Apt. No City State ZIP
__________   _________________    ________________________________________________________________________________________________________
Prex CourseNo. CourseTitle
EQUIVALENCY KNOWLEDGE OBTAINED OVER A PERIOD FROM _________________________________________________________ TO _____________________________________________________________
Explainindetailhowthisknowledgewasobtained(attachadditionalpages).Requestwillnotbeconsideredunlessacomprehensiveexplanationisprovided.
StudentSignature ___________________________________________________________________________________________________  Date ___________________________________________________________
o Eligible for examination o Not eligible for examination Printed Name _________________________________________________________________________
  TransferCreditEvaluatorSignature _______________________________________________________________________________ Date ___________________________________________________________
o Recommended for examination o Not recommended for examination Printed Name _________________________________________________________________________
 AcademicAdvisorSignature _____________________________________________________________________________________ Date ___________________________________________________________
o Approved Printed Name ________________________________________________________________________
  DepartmentHeadSignature _____________________________________________________________________________________ Date ___________________________________________________________
o Approved Printed Name ________________________________________________________________________
 Dean/AssociateDeanSignature__________________________________________________________________________________ Date ___________________________________________________________
  PAID:  Date __________________________________________________  Amount ______________________________________________  Receipt No. ___________________________________________
Examination Date ______________________________________________________________________________________________ Examination Grade _____________________________________________
  ExaminerSignature _________________________________________________________________________  Date ________________________________________________________________________________
  Printed Name ______________________________________________________________________________
 The student o Passed o Failed an equivalency exam for the course listed and o should o should not be given _________________________ semester credits by examination.
  AcademicUnitHeadSignature ___________________________________________________________________________________ Date ____________________________________________________________
Printed Name ________________________________________________________________________
RGR-450-0220
2. ACADEMIC ADVISOR (Must clear with examining department before approval.)
3. EXAMINING ACADEMIC UNIT
4. UNIVERSITY CASHIER (Equivalency Examination Fee)
5. EXAMINING ACADEMIC UNIT
6. ACADEMIC UNIT HEAD OF EXAMINING ACADEMIC UNIT (Must forward to Transfer Credit Oce on completion of form.)
DISTRIBUTION: Original – Transfer Credit Oce; Copy – Student’s Academic Unit; Copy – Student
REGISTRAR USE ONLY: Operator’s Initials _____Date _____________
1. TRANSFER CREDIT EVALUATOR (Must verify all university policies are appropriately met.)
Florida Institute of Technology § Oce of the Registrar § 150 West University Boulevard, Melbourne, FL 32901-6975 § 321-674-8115 § Fax 321-674-7827
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PETITION FOR EQUIVALENCY EXAMINATION (Florida Institute of Technology)

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Completed 29 January 2021

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