Panola College Request for Credit by Examination

Print Name	____________________________________			ID #____ - ____ - ____

I request credit for the following course(s):
_____________________		______________________		____________________

My request is based on the following official test scores which I have provided to Panola College:
	Test	Date Taken	Score
	_____ ACT	___________	___________
	_____ AP	___________	___________
	_____ CLEP	___________	___________

I have read the policies and understand the stipulations concerning my request.
___________________________________________				____________________
Applicant's Signature				Date Requested

Date received in A/RO _______________________
____Granted	____Denied

Comments: _____________________________________________________________________

________________________________			_________________________________
Panola College Official			Action Date

Complete this form and mail to:
Panola College Admissions Office 1109 W. Panola Carthage, Texas 75633

04/30/2008