JACKSON COMMUNITY COLLEGE

APPLICATION FOR CREDIT by EXAMINATION
 
Student Information (Please Print)
Name____________________________________   Student ID No.________________
Address____________________________________________________________________

Telephone        Home Phone (   )________________  Work Phone (   )___________________
 
Please read the following:
1. Upon successfully completing the Credit by Examination test, the student must pay the tuition assessed in order to have the credit posted.
2. The faculty evaluator grades the student’s examination and forwards the completed Application for Credit by Examination form to the Registrar for processing.

3. The Registrar will issue a student transcript reflecting the credits earned.

I have read and understand the information on this form for Credit by Examination.

___________________________________                                      ____________

Student Signature                                                                                  Date
 

Course Information

Course Prefix and No. ___________   Course Name_________________  Credits _______

Date of Examination __________________                            Grade Earned _____________

Have you ever been enrolled in this course at JCC?  __No __Yes       Semester/Year _________
 
Department Approval

Faculty Evaluator  ________________________________     
                                                  Signature

Approved by Department Chair________________________

                                                  Signature   

Approved by Dean    _________________________

                                                  Signature
[Department Chair will forward this completed document  and exam documentation to the appropriate Dean for approval; the Dean’s office will forward to the Registrar]

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Registrar    
The student upon successful completion of the Credit will pay fifty percent (50%) of the prevailing “in-district” per credit hour rate by Examination.
___________        
Credits

___________
Tuition

___________
50%

Cashier

Amount Paid ____________

Date ____________

Processed by Cashier

_____________________
Signature

Receipt No. __________

 Registrar

Processed by Registrar

__________________
Signature 

______________
Date
Transcript mailed _________  Clerk’s initials________  Date__________