Credit for College-Level Learning (CCLL)

Academic Information

Select the program/course you are requesting credit for:

Science of Reading Fundamentals Microcredential

Personal Information

Legal First Name

Middle Name

Legal Last Name

Former Last Name

Birthdate

Email Address

Primary Phone Number

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Mailing Address

Country

Street

City

Region

Postal Code

Demographic Information

Are you Hispanic/Latinx?

Yes

No

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Please indicate your legal sex:

Please indicate your gender identity:

Female

Male

Nonbinary

No

Please indicate if you are one of the following:

U.S. Military Veteran

U.S. Military Service Member - Active Duty

U.S. Reserves National Guard

Spouse of U.S. Military Service member

Child of U.S. Military Service member

Child of U.S. Military Veteran

Dependent of Veteran and/or Service Member

Spouse of U.S. Military Veteran

Not a service member, veteran, spouse or child of service member/veteran

Certification

I understand that this request for credit cannot be processed if it is not complete and correct. Any knowing falsification or omission of data may result in denial of credit.

Signature (please type)

Credit for College-Level Learning (CCLL) - Request