Houston Community College
Prior Learning Assessment Form
First Name: __________________________ Last Name: ___________________________ Student ID: _______________
Phone: ______________________________ Email: ________________________________________
Street Address: _________________________ City: ________________State: _____ Zip: __________
Area of Study: __________________________________________________
Academic Program/Academic Plan/Sub Plan: __________________________________________________
PLA Assessment Options and Fees: Fees are non-refundable and must be paid prior to the start of the evaluation.
Articulated Agreement No Fee
Credit by Exam (Dept. Final Exam) $25 per course
Certification/Training Credit $25 per course
Military Credit No Fee
Mirror Courses No Fee
Work Experience/Portfolio $25 per portfolio
Business Office Application fee paid Yes / No Date: ____________________ (Attach Receipt)
Print/Signature of Pathway and Case Management Advisor: ______________________________
Print/Signature of Program Coordinator/Director or Faculty Division Chair: ______________________________
Date sent to the Department: __________________ Expected date of return: __________________
*This application is a request to have prior learning assessed for college credit. This does not guarantee the award of credit.
**The Dean Signature below indicates that the PLA application has been verified.
Credit by Articulation Agreement
Student has not attempted course for which he/she is pursuing credit
Student successfully completed CEU course/s: Student is seeking Credit for:
Course Prefix Course Number Date of completion Course Prefix Course Number
_________ ______________ __________ _________ ______________
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_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
Dean’s Signature: ______________________________ Print Name: ____________________________ Date: __________
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Credit by Exam: Credit by Final Exam (Credit through exam created by HCC department faculty)
Student has not attempted course for which he/she is pursuing credit
Course Prefix Course Number Date of completion
_________ ______________ __________
Is the test score passing? Yes / No Test Score: _____ Proctored by (initials & ext.): _______________
Awarded Denied
Rationale: __________________________________________________________________________________________
Dean’s Signature: ______________________________ Print Name: ____________________________ Date: __________
Credit by Certification/Training
Student has not attempted course for which he/she is pursuing credit
1. Credit by ACE/NCCRS Workplace Education/Training/Industry Certifications (credit for workplace education or training programs
ACE or NCCRS College Credit Recommendation Service.)
Student is seeking credit for:
Course Prefix Course Number Date of completion Course Prefix Course Number
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________
Awarded Denied
Rationale: _________________________________________________________________________________________
Dean’s Signature: ______________________________ Print Name: ____________________________ Date: __________
Credit by Military
Student has not attempted course for which he/she is pursuing credit
1. Credit by ACE Military Training/Experience (Credit for Military training through American Council on Education. Attach copies of
Joint Service Transcript (JST) formerly AARTS, SMART, transcript.
Student is seeking credit for: Course Prefix Course Number Course Prefix Course Number
___________ ___________ ___________ ___________
___________ ___________ ___________ ___________
2. Credit by CCH (Credit by using College Credit for Heroes crosswalk of military training and experience to WECM courses to identify
matches. Attach JST transcripts (formerly AARTS, SMART transcript) with CCH crosswalk in information.
Student is seeking credit for: Course Prefix Course Number Course Prefix Course Number
___________ ___________ ___________ ___________
___________ ___________ ___________ ___________
VA Director’s Signature: ______________________________ Print Name: ____________________________ Date: __________
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Credit by Mirror Classes (Continuing Education for CEU to CREDIT Articulation)
All credit course prerequisites were met at the time the CE course was taken.
Student successfully completed CEU course/s: Student is seeking credit for:
Course Prefix Course Number Date of completion Course Prefix Course Number
_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
_________ ______________ __________ _________ ______________
Awarded Denied
Rationale: ___________________________________________________________________________________________________
Dean’s Signature: ______________________________ Print Name: ____________________________ Date: __________
Credit by Work Experience/Portfolio
Student has not attempted course for which he/she is pursuing credit.
Student has uploaded their resume.
Personal interview with Dean to describe learning outcomes and evidence needed.
Reference letter(s) from prior supervisor(s)/employer(s) validating specific skill sets aligned with the course learning outcomes
used in the workplace. Company letterhead must be used.
A written narrative (comparable to an end-of-semester term paper) that describes how the student meets the learning objectives
through his/her experience, what has been done, how the student knows what he/she knows, and how he/she links theory and
application. Including all documentation in this paper.
Samples of student produced work that substantiate work required in the course. (If required by department)
Video showing individual performing learning outcomes. (If required by department)
Other evidence determined by Dean and Department Chair as proper documentation.
*Student portfolio must demonstrate prior knowledge and skills, which equate to Student Learning Outcomes (SLO) for the course.
Course Prefix Course Number Date of completion
_________ ______________ __________
Awarded Denied
Rationale: ___________________________________________________________________________________________________
____________________________________________________________________________________________________________
Dean’s Signature: ______________________________ Print Name: ____________________________ Date: __________
Date sent to Enrollment Office: _______________
Date Posted to student records: _______________
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