Prior Learning Assessment
Records office
Credit may be granted for the learning proficiencies acquired through previous training, work or life experiences.
_______________________________________ __________________________________________ __________________________ _______________________________________
Last Name First Name Student ID Phone Number
_______________________________________________ ___________________ ________ __________________ ____________________________________________________
Address City State Zip Code Email
Procedure:
1) Complete the student portion of this form and meet with an Advisor to discuss specific courses which meet your degree
requirements and the method you wish to pursue for alternative academic credit.
2) If necessary, the Academic Dean, or designee, will assign an evaluator who will review the documentation provided by the
student. The Evaluator will return the results to
a) Advisor if none of the courses were approved
or
b) Academic Dean if any of the courses were approved
3) If the results of the evaluation are satisfactory,
a) The form will be forwarded to the Cashier’s Office and the student will be billed the appropriate fee, as applicable.
b) Following payment, the Student Records Office will post the credit “CR” to the student’s transcript.
Please note that “CR”
grades may not be acknowledged when transferring to another college.
c) A copy of the completed form will be stored in the student’s digital academic record.
4) If the results of the evaluation are unsatisfactory, the student will be provided notification via email and/or phone.
5) A copy of this form may be requested by the student at no charge to the student.
Student Information:
I wish to obtain credit for these course(s) based on previous training, work or life experience.
Student signature:_______________________________________ Date:___________________
EvaluatION:
Documentation must be attached
Competency Based
Credits awarded for competency based education derived from a system of instruction, assessment, grading, and
academic reporting; based on students demonstrating they have mastered the knowledge and skills.
$45 per Course
1
Credit by Exam (EX) Institutional Credit by exam; Credit awarded for knowledge-based or juried examinations, including proficiency
and challenge examinations; institutionally developed and enabling students to earn credit through various
methods of testing administered by institutional faculty and approved by academic unit(s).
$25 per course
2
Credit awarded for non-MTAG military coursework, training, or experience.
Credit awarded through student produced, faculty assessed documentation of college-level learning gained
through work and other experiences; may not have resulted in other assessments or certifications.
Other institutional
PLA (PO)
Credit awarded through review of certifications, licensure or other demonstrable competencies gained through
prior experience(s).
Credit awarded from non-educational institution sources not covered by other codes.
Notes:
1. No charge for High School Articulation Agreements. 2. Course fee must be paid prior to administration of exam.
Evaluator signature:________________________________________________ Date:__________________
Academic Dean/Designee signature:_______________________________ Date:__________________
Do not mark below this line. For administrative use only.
Verification:
Total Courses______ x $______/course = $________ Amount Paid Cashiers official signature_______________________________ Date__________________
Total Credit Hours (CR) Awarded_________ Records official signature_______________________________ Date__________________
Form can be returned by: Personal: Bldg. A, Room 200 • Email: recordsdept@terra.edu • Fax: 419.334.9828
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