Application for Missouri S&T Comp Eng 1200
Credit for High School PLTW Students
Missouri University of Science and Technology
Office of the Registrar
Students who have taken the high school Project Lead The Way class (Intro to Digital Electronics) are invited to use this form to apply for three hours of credit for the Missouri S&T Computer Engineering 1200 course (Cp Eng 1200). Students must have taken the PLTW courses at a certified PLTW high school, have an 80 percent average (B) or higher in the classes, and score a 70 percent or higher on the PLTW end-of-course college-credit exams for each class. The fee is $200.
Legal Name in FullLast First Middle
Social Security Number: ______- ______- ______/ Gender: Male Female / Date of Birth: ____ / ____ / ______
Specify year and term in which you seek credit (check one)
Year ______Fall Spring Summer / Citizenship: U.S. Citizen
Non-US; Country: ______
Visa Type, Number, Exp Date: ______
Ethnic Origin (Optional): American Indian or Alaskan Native Asian or Pacific Islander Hispanic
African American, not of Hispanic origin White, not of Hispanic origin Other ______
Your home address : E-mail ______Phone # ______
Street address City County State Zip Code
High School Name: ______City: ______State: _____
Year of Anticipated Graduation from High School: ______
Have you ever enrolled for credit courses through the Missouri University of Science and Technology? Yes No
If yes, please indicate your Missouri S&T Student ID ______
Project Lead The Way Course / Course Grade* / College Credit Exam Score*
Digital Electronics: Semester(s)/Year IED taken: ______
Teacher’s Name: ______Email: ______
Teacher’s Signature: ______
* To receive college credit for PLTW courses, a student must have an 80% or higher average (B) in a PLTW course and score 70% or higher on the PLTW college credit exam.
Total Paid __$200___ Paid via: Check # ______Credit Card (Type: MasterCard/Discover/VISA)
Credit Card Number: ______Please Make Checks Payable to Missouri S&T Expiration Date: ____ / ______Security Code #: ______
Applicant’s signature ______Date of Application: ______
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