CHALLENGE EXAM FORM

Student Information

Name:_____________________________________            I.D. Number (SS#)___________________

Address:___________________________________             Program:___________________________

__________________________________________

__________________________________________            __________________________________

                        Student’s Signature                                                                   Date

Course Information

Course Prefix and Number:____________________   Credit Hours:_____________________________

Course Title:________________________________________________________________________

Part I:             Approval (must be completed prior to sitting for the Challenge Exam)

_________  Written evidence of prior knowledge/proficiency in the subject area (attached)

_________  Recommended to sit for the Exam

_______________________              _________                  _______________________  ___________

Department Chair                                      Date                        Sponsoring Faculty                       Date

_____ Not Approved                   _____Approved                  _______________________  ___________

                                                                                                Academic Dean                            Date

Part II             Financial (must be completed prior to sitting for the Challenge Exam)

________Business Office Arrangements complete                    _______________________  ___________

                                                                                                Signature                                      Date

Part III:          Outcome

Examination score (80% minimum required:__________________(Examination attached)

_________Has met all criteria to receive credit via Challenge Exam Policy

___________________________      _______________      _______________________  ____________

Department Chair                                       Date                       Sponsoring Faculty                         Date

____Approved             ____Not Approved                             _______________________  ____________

                                                                                                Academic Dean                             Date

                                          This form should be printed off, filled out and returned to the Department Chair.