Name of Student (please print) _______________________________________________________

Student Number ________________________________Email ____________________________

Local Address and Phone ___________________________________________________________

______________________________________________________________________________

Permanent Address and Phone ______________________________________________________

________________________________________________________________________________________

Major (if pre-major, state College or DUS) ____________________________________________

Academic Advisor’s Name (please print) ______________________________________________

Advisor’s Office Address and Email __________________________________________________

To the student:  This form does not lead to your receiving credits.  It only certifies that you have been found proficient at the level specified.  The receptionist in the appropriate language department office (see list below) will tell you which instructors or other examiners are authorized to provide certification for your language. 

After the School of Languages and Literatures staff member tells you the name of an authorized instructor or other examiner, it is your responsibility to contact this person, arrange a time to be examined in the language, pay the fee (prior to taking the exam), give the form to the examiner at the time of the exam, and obtain the first two approval signatures in the order shown below. The language examiner -not the student- should return the form to the receptionist in the language department.  (In some cases, at the option of the department, official credentials showing your prior knowledge of the language may be used as an alternative or supplement to an exam.) The language department will then send the completed form to your advisor and give you a copy of the form for your records.  Your advisor can have your language proficiency entered into your official “degree audit” record.

To the advisor or College representative:  The student identified above has been found proficient in the language indicated, at the level indicated.  This form is valid only when all approval signatures are provided.

LANGUAGE ____________________

PROFICIENCY equivalent to completion of the highest Penn State course level that is checked below:

___Language 001 (4th-credit level)

___Language 002 (8th-credit level)

___Language 003 (12th-credit level, which completes the B.A. requirement)

___Language ___ (or 15th-credit level)

___Language ___ (or 18th-credit level)

___Beyond 18th-credit level (may include native speakers)

___Other pattern of equivalency (for example:  3 credits, 6 credits ) _________________________________________________ 

Additional descriptors may also be used (optional).  For example, if only a reading knowledge, or only a conversational knowledge, has been tested, this can be indicated below.

Listening skills 

___not tested

___very minimal or no practical ability to comprehend the spoken language

___able to understand short, basic utterances on everyday topics and immediate situations

___able to understand ideas and details of conversations beyond the immediate situation

___able to understand main ideas and essentials of most or all speech in a standard dialect, when

     listening for personal, social, and professional purposes

___native or native-like ability

Speaking skills

___not tested

___very minimal or no practical speaking ability

___able to handle a range of uncomplicated, basic tasks and simple practical and social situations

___able to satisfy the needs of many everyday situations, including routine school and work

___able to participate effectively in most or all situations and to speak appropriately on practical,

social, academic/professional, and abstract topics

___native or native-like ability

Reading skills

___not tested

___very minimal or no practical ability to understand written material

___able to read short, simple texts dealing with basic practical and social needs

___able to read prose several paragraphs long, and to understand main ideas if not all details

___able to read with complete or almost complete comprehension, including

 academic/professional material and material on unfamiliar subjects

___reading ability of a well educated native or native-like speaker of the language

Writing skills

___not tested

___very minimal or no practical ability to communicate in writing

___able to meet limited practical needs such as writing a short letter

___able to write items such as routine correspondence though there may be some errors

___able to use written expression successfully in most or all formal and informal writing situations,

 including writing on academic/professional topics

___writing ability of a well educated native or native-like speaker of the language

Signatures (obtain in the order indicated):

1. Student.  I have requested Non-Credit Proficiency Certification as indicated on this form.  I have read and understand the policy and procedure statements on this form.

_________________________(signature) _______________(date)

2. School of Languages and Literatures staff member.  With reference to the student indicated on this form, the fee for the language examination and/or evaluation of his/her credentials ($60) has been paid.

____________________________ (printed name)____________________________(signature)  ________________ (date)

3. Examiner (do not administer the exam or evaluate credentials unless both signatures #1 and #2 have been supplied).  I am an instructor or examiner whom the language department, as indicated above, has authorized to verify proficiency in the language shown.  Having examined the student identified above, or having evaluated his/her credentials, I certify that he/she is proficient in the language at the level indicated.

____________________________ (printed name)____________________________(signature)  ________________ (date)

4.  Head of the department offering the language as indicated above, or for other languages, Director of the School of Languages and Literatures

____________________________ (printed name)____________________________(signature)  ________________ (date)                                                      1/30/15