Proficiency Exam Notification
This form is for school system notification of awarding Carnegie credit based on student demonstrated proficiency per Bulletin 741.

If submitting multiple exams, a separate form should be submitted for each course/exam submission. All locally developed exams or portfolio scoring rubrics/performance evaluation requirements must be sent in PDF format to stephanie.marcum@la.gov within 2 days of form submission.

School System *
Date *
MM
/
DD
/
YYYY
School System Contact *
Your answer
Contact Email *
Your answer
Official Louisiana Course Title *
Your answer
Carnegie Unit(s) *
Your answer
Louisiana Course Code *
Your answer
Is there an EOC exam for this course? (If the answer is yes stop here and submit. The EOC exam is the proficiency exam that must be used for this course.) *
Complete this section if the submission does not have an EOC exam.
Type of Exam
Nationally Recognized Exam
Only complete if the exam is nationally recognized. Fill in the official title of the exam below and the score required to earn proficiency credit. Stop here an submit the request.
Nationally Recognized Exam Title
Your answer
Score Required to Earn Proficiency Credit
Your answer
Locally Developed Exam
Only complete If the exam is locally developed. Fill in the title of the exam, the required score to earn proficiency credit, and email a PDF copy of the exam to stephanie.marcum@la.gov. Stop here an submit the request.
Locally Developed Exam Title
Your answer
Score Required to Earn Proficiency Credit
Your answer
Portfolio
Only complete if proficiency is being measured by portfolio. Check if scoring is done by rubric or performance evaluation. Email a PDF copy of the scoring rubric or performance evaluation criteria to stephanie.marcum@la.gov. Stop here and submit the request.
Type of Portfolio Scroring
Submit
Never submit passwords through Google Forms.
This form was created inside of State of Louisiana. Report Abuse - Terms of Service - Additional Terms