University of Illinois Springfield
Internships and Prior Learning Services IPL
One University Plaza MS BRK 482 • Springfield, IL 62703-5407 5.16
217-206-6640 • Fax: 217-206-7415
email@example.com • www.uis.edu/ipl/
Prior Learning Course Application – IPL 305/501
1. The student should complete this form AFTER speaking to his/her academic
2. Once completed, the student should obtain departmental approval on page 2.
3. Submit the completed form to IPL in Brookens 482 or firstname.lastname@example.org; upon
approval, the student will receive an email regarding course approval to
register for the prior learning course, IPL 305 or IPL 501 (graduate credit).
Course Registration for (Semester/Year): ☐ Spring 20____ ☐ Summer 20____ ☐ Fall 20____
Student Name: _______________________________ University ID Number: _______________________________
Phone: _______________________________ UIS Email Address: _______________________________
Academic Program/Major: _________________________ Academic Advisor: _______________________________
Hours completed at UIS: _____________ Total hours completed: _____________
Are you a graduate student? ☐ Yes ☐ No Expected Graduation Date: ___________________________
How did you hear about the prior learning course/program? ___________________________________________________________
Undergraduate students should enroll in 3 credits of IPL 305. If you are seeking more than 3 credits, consult with an IPL
Coordinator to determine the number of credits you may earn.
Graduate students should enroll in 4 credits of IPL 501.
How will you use this credit? (Consult with your advisor if needed.)
ECCE Engagement or ECCE Elective? Number of Credits ______
General Electives? Number of Credits ______
Other? __________________________________ Number of Credits ______
Is this your first prior learning portfolio*? ☐ Yes ☐ No
*If this is not your first portfolio, speak to an IPL Coordinator regarding the process for earning additional portfolio credit.
For IPL Office Use