Fillable Experiential Learning Request (Columbia Basin College)

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Experiential Learning Request (Columbia Basin College)

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The Experiential Learning Request (Columbia Basin College) form is 2 pages long and contains:

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  • 28 other fields

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Experiential Learning Request
In accordance with existing policies and procedures concerning evaluation of certain nontraditional learning experiences,
Columbia Basin College may grant credit for successful completion of such experiences which may be applied toward the
requirements for an Associate in Applied Science degree and/or restricted electives in the Associate in Arts & Sciences degree
and Bachelor of Applied Science degree.
Credit hours will be computed by the College in accordance with current evaluation and accreditation policies concerning nontraditional
learning experiences.
● Experiential Learning credit is granted only for classes that are regularly oered at CBC.
● No credit will be awarded if the student has earned credit in a similar course.
● The student must have earned 15 or more credits at CBC with a GPA of 2.0 or better.
● The student must be enrolled at CBC during the quarter the credit is awarded.
● A non-refundable fee per each credit must be paid for the Experiential Learning assessment.
● Each request for prior Experiential Learning should be directed to the departmental lead or coordinator and/or the Dean.
● Credits awarded will be recorded with a “P” grade and are specifically identified on the transcript as credits for prior
Experiential Learning.
● One-fourth of the total credits required for a CBC degree or certificate may be earned through the Experiential Learning
assessment process.
● Prior Experiential Learning credits do not count toward the minimum CBC residency requirement.
Complete all sections in sequential order.
Section 1: To be completed by student
1. Make arrangements for the Experiential Learning assessment with the departmental lead or coordinator and/or the Dean.
2. Complete this section.
3. Pay the non-refundable fee to Hawk Central and attach receipt to this form (Section 2).
4. Present this form to the departmental lead or coordinator and/or the Dean.
Name: Student ID Number:
Quarter/Year: CBC course for which credit is being requested:
Are you currently enrolled?
q
YES
q
NO
Source of Learning Experience
Please attach certificates or other documentation to support request for credit.
Training Sponsor Location Subject Dates (From/To)
I certify that I satisfactorily completed the above learning experience and apply for college credit in accordance with existing
college accreditation and evaluation policies.
Student Signature
Date
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Section 2: To be completed by student
● Pay the non-refundable fee to Hawk Central and attach receipt to the form.
Section 3: To be completed by the departmental lead or coordinator and/or the Dean
1. Coordinate the date/time for the Experiential Learning assessment with the student.
2. Upon completion of the Experiential Learning assessment, complete this section.
3. Certify that the student has shown competence and knowledge for the course(s) at a performance level of a 2.0 grade point
minimum and has earned the grade of “P”.
4. Departmental lead or coordinator must submit form to dean for signature. DO NOT return the form to the student for
processing.
CBC Course ID Satisfied Credits Approved Evaluation Methodology
q
q
q
I certify the student has shown competence and knowledge for the course(s) indicated above at a performance level of a 2.0
grade point minimum and has earned the grade of P.
Departmental Lead or Coordinator Signature Date
Dean Signature Date
Submit completed and approved form to:
Student Records
Mail Stop: H4
Section 4: To be completed by Student Records
Course Credits Approved
q
q
q
Registrar Signature Date
Rev 12’19
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and armative action. CBC does not discriminate on the basis of race, color, creed, religion, national or ethnic origin, parental status
or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed
by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Aairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548.Individuals with disabilities are
encouraged to participate in all college sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
We are temporarily accepting this form via email while our campuses operate remotely.
Deans, please submit the completed form and documentation to Janet Garza via email.
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Completed 21 July 2020

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