Competency Pre-Assessment Request
Student Information
Student ID
*
Student Email
*
example@example.com
Title
*
Mr.
Mrs.
Ms.
Student Name
*
Degree
*
Undergraduate
Masters
Doctoral
Contact Number
*
Program
*
Artificial Intelligence and Computer Engineering
Artificial Intelligence Innovation
Electrical and Computer Engineering
Technology and Creative Innovation
Current Semester
*
Fall
Spring
Summer
Year
*
Information
Have you spoken with your academic advisor(s) regarding the request?
*
No
Yes
Academic Advisor Name
*
Email
*
example@example.com
Have you spoken with the course instructor regarding the request?
*
No
Yes
Instructor Name
*
Email
*
example@example.com
Please fill out the course you wish to request an assessment:
Course Number & Course Name
*
Course Instructor(s)
*
Course Unit(s)
*
List of student work or assessment activities
*
0/80
Please read the texts and tick the boxes.
*
I understand that the instructor has the right to reject a request if I do not demonstrate adequate mastery of a competency or if I do not provide sufficient proof of mastery.
I declare that enclosed with this form is proof of my own work or assessment for the course instructor to review.
Signature of Student
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
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