Fillable Credit-for-experiential-learning-application - APP FOR CEL

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Credit-for-experiential-learning-application - APP FOR CEL

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!!1101!Sherman!Drive,!Utica,!NY!13501!
!!!!!!!!!!!!!!!!Phone!(315)!792=5336!
!!!!!!!!!!!!!!!!!!Fax!(315)!792=5698!
!!!!!!!!!!!!!!!!!!!!!!www.mvcc.edu!
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Mohawk Valley Community College grants college credit to enrolled matriculated students for
demonstrated knowledge acquired from work experience, non-credit courses, seminar training
and workshops. Please refer to the complete Credit for Experiential Learning Policy for details.
Student Name _________________________ M# _________________________
Permanent Home Address _______________________________________________________
_______________________________________________________
Home Phone _________________________ Personal Email _________________________
Business Address ______________________________________________________________
______________________________________________________________
Daytime Phone _________________________ Business Email _________________________
I wish to receive credit for Course #: _________ Title: __________________ Credit: __________
Academic Center ________________________ Degree/Certificate Program ________________
I have read the CEL policy and I confirm that:
• I am a matriculated student and currently enrolled in a program at MVCC
• I have not taken this course previously at MVCC
• The course is offered in the current MVCC catalog and is either required or an elective in my current
program
• I have not been granted more than 30 transfer credits in my program
_______________________________________________________________________________
Student Signature Today’s Date
Please submit this form to the Associate or Assistant Dean of your Academic Center
OFFICE USE ONLY
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Rec eived!By/Date!_ ___________________!
!
APPLICATION FOR CREDIT
FOR
EXPERIENTIAL LEARNING (CEL)
!
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!1101!Sherman!Drive,!Utica,!NY!13501!
!!!!!!!!!!!!!!!!Phone!(315)!792=5336!
!!!!!!!!!!!!!!!!!!Fax!(315)!792=5698!
!!!!!!!!!!!!!!!!!!!!!!www.mvcc.edu!
STEP 1: To Be Completed by the Registrar
Student Name _____________________________________ ID# _______________ Term _______________
Current Major _____________________________________ ☐No graduation (AW) from this major
☐Course not taken before ☐No more than 30 transfer credits count toward program
________________________________________________________________________________________
Registrar/Asst Signature Date
STEP 2: To Be Completed by the Academic Center in which Student is Matriculated
This course will apply to the matriculated major:
Course # __________________ Title _____________________________________ Credit _______________
How will the course apply? ☐Major Course ☐Elective ☐General Education Course
Notes ___________________________________________________________________________________
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
STEP 3: To Be Completed by the Academic Center in which the Course is Housed
Course # __________________ Title _____________________________________ Credit _______________
Assigned Faculty Mentor _____________________________________
Notes ___________________________________________________________________________________
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
STEP 4: To Be Completed by the Business Office
Course # __________________ Title_____________________________________ Credit _______________
Paid Amount _______
________________________________________________________________________________________
Business Office Verification Date
APPLICATION FOR CREDIT
FOR
EXPERIENTIAL LEARNING (CEL)
!
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3!
1101!Sherman!Drive,!Utica,!NY!13501!
!!!!!!!!!!!!!!!!Phone!(315)!792=5336!
!!!!!!!!!!!!!!!!!!Fax!(315)!792=5698!
!!!!!!!!!!!!!!!!!!!!!!www.mvcc.edu!
STEP 5: To Be Completed by the Faculty Mentor (Initial Review)
I have received the CEL Application and the student has agreed to submit a narrative of learning outcomes and
a portfolio by __________________.
(Due Date)
Comments _______________________________________________________________________________
________________________________________________________________________________________
Faculty Mentor Signature Date
STEP 6: To Be Completed by the Faculty Mentor (Final Review)
I have reviewed the narrative of learning outcomes and any portfolio. ☐Pass ☐Fail
Comments _______________________________________________________________________________
________________________________________________________________________________________
Faculty Mentor Signature Date
STEP 7: To Be Completed by the Academic Center in which the Course is Housed
I acknowledge receipt of faculty work and award _______ credit hours for _____________________________.
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
STEP 8: To Be Completed by the Academic Center in which Student is Matriculated
I acknowledge receipt of notification of credit awarded (or denied).
________________________________________________________________________________________
Dean or Assoc/Asst Dean Signature Center Date
Please attach a copy of the narrative of learning outcomes satisfied and return this completed form to
Rosemary Spetka, Registrar, PH 140.
OFFICE USE ONLY
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Rec eived!By/Date!_ ___________________!
Posted!By/Date!____________________!
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CEL Application
Revised 6/24/14
APPLICATION FOR CREDIT
FOR
EXPERIENTIAL LEARNING (CEL)
!
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Completed 9 February 2020

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