JohnstonCommunityCollegeAOM Revised6/11
RequestforCreditbyExperienceForm
StudentNamePhonenumber
Mailingaddress
DegreeProgram StudentIDNumber
CourseTitle,prefixandsectionnumber
Courseprerequisite(s)
TOTHESTUDENT:CreditbyExperiencemaynotbegrantedifcredithasbeenattemptedany
otherwayandallprerequisite(s)mustbemet.Documentationmustbeprovidedthatproves
youhavemetcoursecompetenciesandhavedemonstratedknowledgeofatleast80%of
coursecontent.Scheduleameetingwithaninstructorqualifiedtoteachthiscourseandreview
acoursesyllabuswiththeinstructortoensurecompetenciesandcontentknowledgehavebeen
met.Asyllabusandallotherdocumentationmustaccompanythisrequestandmaybecome
thepropertyofJohnstonCommunityCollege.
TOTHEINSTRUCTOR:Pleaseusethecoursecompetenciesandcontentasachecklistfor
verifyingastudent’sknowledge&/orskilllevel.Commentsonthesyllabusmayserveas
documentationthatthestudenthasmetatleast80%ofthecontent.Otherdocumentation
maybe,butisnotlimitedtoportfolios,writingsamples,transcripts,certificatesorother
examplesofstudentgeneratedworkappropriatebasedonindividualcourserequirements.
Instructor’srecommendation Approve Disapprove
Signaturesrequiredforapproval
Instructor________________________________________________ Date_____________
DirectorofProgramforCourse_______________________________ Date_____________
DeanforCourse___________________________________________ Date_____________
DeanforDegreeProgram___________________________________ Date_____________
VicePresidentofInstruction________________________________ Date_____________
Registrar_________________________________________________ Date_____________
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