1. APPPLICATION FOR INDUSTRY-BASED CERTIFICATION CREDIT
      2.                                 
      3. PART 2
      4. PART 3

 
TYPE OR PRINT CLEARLY
 
 



APPPLICATION FOR INDUSTRY-BASED CERTIFICATION CREDIT
 

 
 

 TO:  Office of the Registrar          DATE:

 

 
             
FROM:
Name of Student (Last, First, MI) Stud. ID #
Division / Major       Program



                                

Name of Industry-Based Certification*    Course(s) Credit Initially Requested
 (Attach copy of dated valid certification)

PART 1

 I am presently enrolled at Delgado. I certify that the attached certification documentation is valid, and I understand I am subject to the College’s Student Judicial Code if this documentation is deemed to be falsified. I understand that credit may not be awarded for the certification being reviewed . As my official record indicates, I have never registered for this course(s) in any college or university.

Received by Dean of Division Housing Course(s)
____________________________________
________________________________________________
Student’s Signature Name/Title
 
____________________________________
_________________________________________________
Date Signature          Date
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PART 2
 
APPROVAL:

  
The student above is currently enrolled and has submitted the following Industry-Based Certification (attached). This certification IS included on the current College’s Industry-Based Certification Crosswalk, and therefore, based on this established crosswalk of prior learning assessment credit for the specific coursework, the following credit is approved:
        
Industry-Based Certification
Certification Date
   
    
Course(s) and Credit Hours to Be Awarded
Dean of Division Housing Course(s):
      
_________________________________________
_________________________________________
Print Name/Title Signature       Date
    
DISAPPROVAL/RECOMMENDATION
The student above has submitted the attached certification, which is NOT included on the current College’s Industry-Based Certification Crosswalk. Therefore, credit is denied at this time. If the certification is in an acceptable time range to ensure current training relevance, then the student is encouraged to immediately pursue the  Life Experience Assessment Program (LEAP) process to determine if credit should be awarded.
Dean of Division Housing Course(s):
_________________________________________
_________________________________________
Print Name/Title Signature       Date
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PART 3

                                                                           
Received by Registrar’s Office:  __________________________ (Initials)  ___________________ (Date)
Original: Registrar’s Office; Copies: Student; Division Housing Course(s) File
Form
Form 1433/001 (2/07)
Form 1435/003 (11/21)

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