Portfolio Assessment Credit Request Form
Instructions to Students:
To officially receive credit for previous training or experience, you should consult your advisor to discuss the feasibility
of pursuing the credit. Developing a portfolio is a rigorous process where you will reflect upon and assess your
experiences in order to determine what you have learned and how that knowledge and skill applies in other contexts. If
the credit seems possible:
I. Review PLA Guide, Portfolio Application Procedure
II. Compile Portfolio and List the courses for which credit is desired on this form
III. Schedule a meeting with the PLA Coordinator to review portfolio
IV. Pay portfolio fee to Business Office, request a receipt
V. Return the portfolio development form, receipt of payment, and portfolio to PLA Coordinator
VI. PLA coordinator submits Portfolio to all approving parties & student will be notified of results
NOTE: Requested credit must meet a student’s degree requirement (see student’s Degree Audit).
Step 1: Student Information Section (Must be completed prior to assessment)
Name: ____________________________________________________ ID or SS#: _____________________________
Address: _____________________________________ City: ____________________ State: _______ Zip: ________
Step 2: Credit Requested (A separate form must be submitted for each course)
List all courses for which credit is desired: (if requesting more than five classes please fill out another form)
Course Prefix & Number Course Name
PLA Coordinator Signature: ________________________________________________________________________
Step 3: Business Office Section (Must be completed prior to assessment)
Portfolio Fee + Tuition: _____________ Receipt Number: _________ Date Paid: ________ Received by: ______
Step 4: Signatures (Required if approved in Step 4)
______________________________ ______________ ______________________________ ______________
1. Division Chairperson Date 3. Registrar Date
______________________________ ______________
2. Chief Academic Officer Date