Petition for alternative
Credit may be granted for the learning proficiencies acquired through previous training, work or life experiences.
_______________________________________ __________________________________________ __________________________ _______________________________________
Last Name First Name Student ID Phone Number
_______________________________________________ ___________________ ________ __________________ ____________________________________________________
Address City State Zip Code Email
Please complete the following information. Processing may take two weeks, unless waived by Student Records Office.
1. Complete the student portion of this form and meet with an Advisor to discuss specific courses which meet your degree
requirements and the method you wish to pursue for alternative academic credit.
2. If necessary, the Academic Dean, or designee, will assign an evaluator who will review the documentation provided by the
student. The Evaluator will return the results to the Advisor or Academic Dean for approval.
3. If the results of the evaluation are satisfactory,
a. The form will be forwarded to the Cashier’s Office and the student will be billed the appropriate fee, as applicable.
b. Following payment, the Student Records Office will post the credit “CR” to the student’s transcript.
Please note that “CR”
grades may not be acknowledged when transferring to another college.
c. A copy of the completed form will be stored in the student’s digital academic record.
4. If the results of the evaluation are unsatisfactory, the student will be provided notification via email and/or phone.
5. A copy of this form may be requested by the student at no charge to the student.
I wish to obtain credit for these course(s) based on previous training, work or life experience.
Student signature:_______________________________________ Date:___________________
Documentation must be attached
Method used for Alternative Credit Fee
Articulation Agreement (High School, Career Technical Program, A.P.) No Charge
Military Training No Charge
Experiential Learning (Work/Life Experience) $45 per course
Recognized Certificate or License (Apprenticeship) $45 per course
Other Training or Instruction $45 per course
Evaluator signature:________________________________________________ Date:__________________
Academic Dean/Designee signature:_______________________________ Date:__________________
Do not mark below this line. For administrative use only.
Total Courses______ x $45/course = $____________ Amount Paid Cashiers official signature_______________________________ Date__________________
Credit Awarded Credit Denied Records official signature_______________________________ Date__________________
2830 Napoleon Road • Fremont, OH 43420-9670 • 419.559.2333 • or 866.AT.TERRA, ext. 2333 rev. 9/14
Form can be returned by: Personal: Bldg. A, Room 200 • Email: email@example.com • Fax: 419.334.9828