EVALUATION FOR LIFE EXPERIENCE CREDIT

Student Name:_________________________            Social Security #:_______________

Address:________________________________________________________________

_______________________________________________________________________

Phone #:_____________________     Major:____________________          Date:_______

Life Experience Evaluation for Course:________________________________________

Materials Submitted:

                                    □ Cover Letter

                                    □ Student Resume

                                    □ Verification of Employment

                                    □ References

                                    □ Job description/narrative of related job

Please submit one application and supporting documentation for each course you are requesting

Life Experience for.

Materials have been reviewed and evaluated.                Credit for______________________

□IS     □IS NOT recommended.

______________________                __________________________________________

            Date                                                                 Faculty Signature

______________________                __________________________________________

            Date                                                            Department Chair Signature

□  Approved

□  Denied

______________________                __________________________________________

            Date                                                             Academic Dean Signature

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