THE UNIVERSITY OF TENNESSEE AT MARTIN

                            APPLICATION FOR PROFICIENCY EXAMINATION

Fill in highlighted sections only (bold print); obtain Registrar's verification of eligibility to take proficiency examination; obtain signature of the dean of your school; pay fee at Business Affairs Office (AD116).  Present completed form to the instructor before the test is administered.  The instructor should indicate a grade on this form and turn in the original copy to the Officeof Academic Records as soon as the test is administered.

Currently Enrolled  ___________  Present Address  __________________________________

Date of Birth  _____________   Major  _____________________    Classification  _________

Course Name  __________________  Course Number______   Course Title _______________

Preparation  (state fully)  ________________________________________________________

___________________________________________________________________________

__________________________________________________________________________

Have you ever failed this course  ______  Have you taken this course for credit or audit  _______

Signature  ________________________________________      Date ________________

 

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If you approve of the proficiency examination requested above, please indicate by signing your name and date in the space provided.

 

________________________________________            Date  _____________________

                              Registrar

 

_______________________________________            Date  ______________________

                              Dean

 

_______________________________________            Date  _____________________

                      Business Affairs

To be filled in and returned to Office of Academic Records by the instructor administering the test after the test is graded.   GRADE  ________   INSTRUCTOR  _______________________________   DATE  ____________