OFFICE OF THE UNIVERSITY REGISTRAR
Mailing Address: P.O. Box 1796 • Edmonton, Alberta, Canada T5J 2P2
Phone: 780-497-5000 • Toll Free: 1-888-497-4622
Website: www.MacEwan.ca • E-mail: info@macewan.ca
FREEDOM OF INFORMATION & PROTECTION OF PRIVACY
Protection of Privacy - The personal information requested on this form is collected and protected under the authority of Part 2 of the Alberta Freedom of Information and Protection of
Privacy Act and the Post-Secondary Learning Act. It will be used for the enrollment process and student management consistent with that purpose. This information will be entered into and
retained in the ofcial university student information system database. Direct questions expressly related to the collection and use of this information to the Associate Registrar, Records,
Ofce of the University Registrar, MacEwan University, 10700-104 Avenue, Edmonton, AB, T5J 4S2, telephone 780-633-3110.
PRIOR LEARNING RECOGNITION FORM
PLEASE READ INSTRUCTIONS ON SECOND PAGE BEFORE SUBMITTING THIS FORM
PART 1
PART 3
PART 2
STUDENT ID NO.: FAMILY (LAST) NAME: FIRST NAME: MIDDLE NAME:
PROGRAM OF STUDY:
I AM APPLYING FOR CREDIT IN THE COURSE LIST BELOW THROUGH PRIOR LEARNING ASSESSMENT AND RECOGNITION (PLAR). I ACKNOWLEDGE THAT I HAVE READ POLICY C2010 - PRIOR LEARNING
ASSESSMENT AND RECOGNITION AND THE INSTRUCTIONS OF THE REVERSE SIDE OF THIS FORM.
COURSE # (E.G., ACCT 111): __________________________________________________________________ COURSE NAME: _____________________________________________________________________________
STUDENT’S SIGNATURE: _____________________________________________________________________ DATE: _________________________________________
FEE ASSESSMENT
$40 APPLICATION FEE ASSESSMENT RESULTS POSTED TO STUDENT RECORD
ADDITIONAL FEE $_____________________ DATE: ___________________________________ SIGNATURE: _______________________________
TOTAL FEE $ __________________________
FEES ASSESSED
DATE: _________________________________ SIGNATURE: ___________________________________
1. CHALLENGE EXAM
CHALLENGE EXAM DATE _________________________ TIME _________________________________
LOCATION _____________________________________________________________________________
MINIMUM GRADE REQUIRED FOR CREDIT ______________________________________________
2. OTHER PLAR ASSESSMENT
ORAL EXAM / INTERVIEW
DATE __________________________________ TIME ________________________________________
LOCATION _____________________________________________________________________________
PERFORMANCE ASSESSMENT
DATE __________________________________ TIME ________________________________________
LOCATION _____________________________________
PORTFOLIO ASSESSMENT
SUBMISSION DATE _____________________ RECEIVED BY (NAME) _________________________
RETURN DATE _________________________________
CHAIR NAME: _______________________ DATE: _______________________
CHAIR SIGNATURE: ____________________________________________
TO BE COMPLETED BY THE STUDENT
TO BE COMPLETED BY THE OFFICE OF THE UNIVERSITY REGISTRAR
TO BE COMPLETED BY THE PROGRAM CHAIR (OR DESIGNATE)
B. ASSESSMENT RESULTS
Credit Awarded
Challenge Examination Grade: ________
Credit Not Awarded
The grade awarded for credit earned through PLAR is recorded as ‘CR’ (Completed
Requirements) except in the case of Challenge Exams where the grade earned is
recorded. See Policy C2020 - Grading.
Assessor/Examiner Name: _______________________ Date: _________________
Assessor/Examiner Signature: _____________________________
A. ASSESSMENT APPROVAL
Assessment by PLAR Approved
Assessment by PLAR Not Approved
PROGRAM FEE ASSESSMENT
THE PLAR FEE IS $40 PLUS THE APPLICABLE PROGRAM FEE NOT TO EXCEED 75% OF THE COURSE TUITION FEE
PROGRAM ASSESSMENT FEE $ ______________
DIVISION ______________________________ BUDGET ACCOUNT __________________________
CHAIR SIGNATURE ____________________________ DATE: __________________
PAYMENT METHOD
DEBIT
CHEQUE
PERSONAL INFORMATION COLLECTION NOTICE
The personal information requested on this form is collected under Section.33(c) of the Freedom of Information and Protection of Privacy Act for the purpose of one or all
of the following: to determine eligibility for admission and financial assistance, to advise students about academic programs and to provide university services at MacEwan
University. Questions concerning this collection should be directed to the Lead, Privacy and Information Management at privacy@macewan.ca
