Fillable Delta College CREDIT-BY-EXAM REGISTRATION form 2019

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Delta College CREDIT-BY-EXAM REGISTRATION form 2019

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DELTA COLLEGE TESTING CENTER
1961 Delta Road, A133
University Center, MI 48710
Phone: (989) 686-9182
Fax: (989) 667-2213
CREDIT-BY-EXAM REGISTRATION
NOTES BEFORE REGISTERING
• It is the student’s responsibility to check with the Counseling and Advising Office to determine if they
have met all required prerequisites before taking the exam.
• Read Credit-by-Exam Validity Statement before you complete and submit this registration form.
• Include payment information with registration form.
• The Testing Center does not administer Credit-by-Exams the last two (2) weeks of any semester.
STUDENT INFORMATION
EXAM INFORMATION
Name:
Address:
City, State, Zip:
Phone:
Delta Email:
Delta ID:
Course Number:
Course Title:
Credits:
Choose One:
☐ Credits ☐ Waiver
Appointment
Preferences:
APPOINTMENT INFORMATION
OFFICE USE ONLY – DO NOT WRITE
Exam Date:
Time:
Reschedule:
Time:
PROCTOR AND FACULTY
The above CBE was administered on the following date: ______________________________________________
The results_________ ☐ qualify ☐ do not qualify the above named student to earn credit or waive this course.
Proctor Signature Date
Faculty Signature Date
Faculty Signature Date
Faculty Signature Date
DELTA COLLEGE ADMINISTRATION FEE: $35 PER TEST
Discover/MasterCard/Visa
(American Express not accepted)
Number
— — —
Expiration:
CVV:
Cardholder Name:
Billing Address, State, Zip:
L:\PROJECTS\LLIC\Testing Center\Forms\CBE Registration Form 2019.docx
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Delta College CREDIT-BY-EXAM REGISTRATION form 2019

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Completed 7 February 2020

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