Wufoo

Student Information
Name * First Last
NECC ID: *
Date of Birth * MM / DD / YYYY
Phone Number * ### - ### - ####
Email *
Program of Study *
Credit for Prior Learning option: *

Additional information is available at: www.necc.mass.edu/engage/aptc/testing-services/credit-prior-learning/
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Attach supporting documents (i.e. resume, transcript).
Course Information
Course Number
Course Title
# of credits

Enter the number of the course credits for which you are attempting to receive.
Additional Information (let us know if you are working with a faculty member or advisor):
STATEMENT OF DISCLOSURE *
By checking this box, you have read the Statement of Disclosure

I understand that the awarded credit can be applied toward completion of my current program of study at Northern Essex Community College and that credits earned through Credit for Life Learning may not transfer to another academic institution. I also understand that fees are due prior to administration of the Credit for Life Learning option. The fees are applied to the expenses incurred for exam preparation, administration, and grading. Therefore, fees are not refundable regardless of my performance on the evaluation or exam. Academic Area approval of this request, when required, does not certify or guarantee my ability to be successful on this evaluation or exam. Credits earned by evaluation or by exam do not apply toward academic residency requirements. I also understand that I must obtain a minimum of a “C” in order to be awarded credit, my transcript will reflect a “P” (Pass) and not a letter grade, and the “P” will not impact my grade point average.
Payment Information
Payment method, $40 admin fee and $50 per credit fee, check one: *
Destiny One online payment system Mail-in Not required (Articulation, Military, Pathway to Credit Courses)

3 credit course/$190 and 4 credit course/$240.

Select Credit for Prior Learning Option and follow Registration payment link

Mail-in money order, made payable to NECC, and send to NECC, 100 Elliott St., Haverhill, MA 01830, Academic Placement & Testing
Electronic Signature *
Date * MM / DD / YYYY
Do Not Fill This Out

Wufoo

Student Information

Course Information

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