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PROFICIENCY EXAMINATION REQUEST (Danville Area Community College)

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PROFICIENCY EXAMINATION REQUEST
DATE: ____________________________ DIVISION: ___________________________________
_________________________________ _____________________________
STUDENT NAME (please print) STUDENT ID NUMBER
_____________________________________________________________________________________________
COURSE TITLE COURSE NUMBER CREDIT HOUR(S)
Request is made to take a proficiency examination in the above course. Examination is given only by
approval and payment of examination fees (fee shall be a minimum of one credit hour tuition or one-half
the current tuition charged by the College for that course, whichever is greater).
______________________________________________________ Approved Not Approved
DIVISION CHAIRPERSON Date
____________________________________________________________ Fee paid (Receipt Attached)
BUSINESS OFFICE Date
____________________________________________________________ Approved Not Approved
REGISTRAR Date
This is to certify that __________________________________ has has not
successfully passed the proficiency examination for ____________________________________
Course
on _________________________.
Date
___________________________________________ ___________________________________________
Instructor Division Chairperson
All regulations and procedures governing proficiency examinations as stated in the College Catalog have
been met. Please enter proficiency credit on the student’s permanent record.
__________________________________________________________
Vice President for Instruction Date
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PROFICIENCY EXAMINATION REQUEST (Danville Area Community College)

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Completed 15 September 2020

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