Request for Credit Form

Request for Credit

Admissions & Records Office | 309.341.5233 | asnow@sandburg.edu
Student Name:*

First NameLast Name
Student Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I request that I be granted credit for Type Course # and Name* in the Type Program Name* program for the following reason(s):
Type Comments:*
Please attach any pertinent supporting documents such as form DD 214, etc.

Cancelof
Signature*

Clear
Date*

MonthDayYear
**********Office Use Only**********

________ Credit Hours Awarded

________ No Credit Awarded

Reason:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________ _________________
Registrar Date
Should be Empty: