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
ipl@uis.edu • www.uis.edu/ipl/
Prior Learning Course Application IPL 305/501
1. The student should complete this form AFTER speaking to his/her academic
advisor.
2. Once completed, the student should obtain departmental approval on page 2.
3. Submit the completed form to IPL in Brookens 482 or ipl@uis.edu; 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 INFORMATION
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
DATE RECEIVED:
COURSE:
CRN:
APPROVAL:
IPL 305/501
If you have questions, please email Rachel Price at rpric3@uis.edu or call 217-206-6695.
1. Describe, in detail, the proposed prior learning experience you wish to receive credit for (e.g., professional training; certification;
volunteer work; military service; individual research; independent study; travel).
2. Briefly explain how you believe what you learned in this experience can be applied to situations outside of the setting in which you
learned it.
UIS DEPARTMENT/ADVISOR APPROVAL
The student must seek approval from a faculty member, academic advisor, or department chair in his/her department.
DEPARTMENT SIGNATURE
I agree that this student should complete the prior learning course for his/her degree progress.
Printed Name: _____________________________ Signature:____________________________________ Date:____________
STUDENT VERIFICATION
I verify that I have not received credit nor attempted to receive credit from the University of Illinois Springfield or any other
higher education institution on the basis of the work I will prepare for this portfolio.
Student Signature: ________________________________________________ Date:________________
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