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Challenge for Credit Application Form by asb28647

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									                                                                        Challenge for Credit
                                                                                                                                         STUDENT ID NUMBER (if applicable)




                                                                        Application Form                                                 FOR OFFICE USE ONLY


Office of the Registrar, Athabasca University                           Before you complete this form, please consult
                                                                                                                                          SPONSORING CLIENT ID NUMBER
1 University Drive, Athabasca, AB T9S 3A3                               the course professor to determine the method of
Toll Free in Canada/US: 1.800.788.9041                                  assessment (examination, project, examination/
Other: 780.675.6111, Fax: 780.675.6174                                  project etc.). Review the AU Calendar, Section 6.4                REFERENCE NUMBER

www.athabascau.ca                                                       Challenge for Credit:
                                                                        www.athabascau.ca/calendar/page06_04.html.


General                                            Student Name:      _____________________________________________________________
Information                                                           LAST                     FIRST                            MIDDLE

(please print)
                                                 Mailing Address:     _____________________________________________________________
                                                                      _____________________________________________________________
                                                                      CITY/TOWN                               PROVINCE/STATE

                                                                      _____________________________________________________________
                                                                      COUNTRY                                 POSTAL/ZIP CODE

                                                       Telephone:     (_____)________________________(_____)_________________________
                                                                      (AREA CODE) RESIDENCE                    (AREA CODE) BUSINESS

                                                        Fax/E-mail:   (_____)________________________(_____)_________________________
Course Fee                                                            (AREA CODE) FAX                          EMAIL

Information
Course fees do not include the course                            r    Course name and number: _______________ Credit weight: _______________
materials learning resources package.                            r    Course fee excluding the optional course materials learning resources fee
For an additional fee, you may purchase                               (Fees: www.athabascau.ca/calendar/page05_05.html): _______________________
the learning resources package.
                              	                                  r	   Course fee including the optional course materials learning resources fee
                                                                      (Fees: www.athabascau.ca/calendar/page05_05.html): ______________________
                               	                                 r	   Courier the course materials learning resources package at my expense.
The personal information collected on this form will be
                               	
used for the purpose of processing payments. This personal       r	   Charge applicable fees to my credit card:
information is being collected under the authority of Section
33(c) of Alberta’s Freedom of Information and Protection of
                                                                      ______________________________________________/_____________________________
Privacy Act. If you have any questions about the collection
and use of this information, contact the Senior Accountant,           CREDIT CARD NUMBER                                         EXPIRY DATE
Athabasca University, 1 University Drive, Athabasca, Alberta,
T9S 3A3, Phone: 800.788.9041.                                         Examination and invigilator information also apply to challenge for credit
                                                                      students. When you are nearing your project or examination write date, please
The personal information collected on this form will be
used to process your challenge for credit application. This           complete and submit the Examination Request Form. Allow one month for the
information is collected under the authority of section 33            preparation and delivery of your examination (if applicable) to your invigilator.
(c) of Alberta’s Freedom of Information and Protection of
Privacy Act. If you have any questions about the collection
and use of this information, please contact the Coordina-
tor, Academic Records and Examinations, Office of the
                                                                 r    I have consulted the course professor (required).
Registrar, Athabasca University, 1 University Drive,             r		I am including the Examination Request Form.
Athabasca, AB Canada T9S 3A3. Phone: 800.788.9041.
                                                                 r    I will submit the Examination Request Form at a later date.




                      Student signature:____________________________________________________                                   Date: ___________________




                                                                                                                                                                 June 09

								
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