VALENCIA Application for Credit by Examination East Campus Business, I.T., and Public Services Department Bldg. 8, Room 105 Name: _____________________________________ Valencia Student Number __________________ (Please Print)
Atlas Email: _____________________________________ Telephone:_________________________ I request permission to take _________________ (Course Number)
________________________________________ (Course Title)
for ____________ credit hours through credit by examination on _____________________________ (date, time)
I will need accommodations through the Office of Students with Disabilities (OSD). Yes
□ No □
I have received a Student Packet and have reviewed the policies outlined in this packet that pertain to this examination. I understand that credit earned by examination for this course may not be acceptable for transfer to other institutions. If I wish to transfer this credit, it is my personal responsibility to contact the institution to which I am transferring and determine its policies regarding the acceptance of credit by examination credits. I further understand that in order to receive credit, I must be a student at Valencia Community College. No refunds are available for this examination. _____________________________ (Date)
______________________________________________ (Student’s Signature)
_____________________________ (Date)
______________________________________________ (Department Signature)
$15.00________________ (Examination Fee)
______________________________________________ (Finance - Receipt of Fee Assessment)
Completed application must be returned to the campus department office listed above after the fee has been paid. 1. Department Copy
2. Student’s Copy
3. Test Proctor’s Copy