Form Revised 11-16-2018
Student Application for
Prior Learning Assessment (PLA)
The Prior Learning Assessment process gives adult learners the opportunity to earn college credit for
college-level learning. Students must complete the college admissions process and the online orientation
prior to requesting a PLA.
Student Name: Student ID:
Phone: GTC Email Address:
Program of Study/Major: Term:
My signature below indicates that all the information provided is accurate, and I take full responsibility for providing all
information required.
Student Signature: Date:
STEP 1: Identify courses and why you seek exemption
riefly explain why you think the PLA program is a good match for your background and for which course(s) you
desire exemption. College-level learning may be validated by examination, professional certifications, work
experience, military experience, non-credit courses, or portfolios.
Course Prefix/Number Specific Prior Learning Experience Applicable to Course
STEP 2: Schedule an appointment
edule an appointment with the PLA Evaluator
or Academic Program Director of your program to review your
request. Bring this form and any documentation that supports your college-level learning request to this meeting.
The possible next steps will be discussed during this meeting.
For Department Use Only
by PLA Evaluator, Academic Program Director, or Department Head
Date of Meeting: Status: Proceed with Process Not eligible to proceed with process
Printed Name of Evaluator: Signature of Evaluator:
Note: PLA evaluator or Academic Program Director send completed form to PLA Director and Student Records along
with any documentation required.
STEP 3: Pay your fees (if applicable)
applicable, pay the assessed fee indicated below at the Business Office. The Business Office will stamp this
form paid and provide a receipt of payment.
Course Prefix & Number: Credit Hours: Type: Fee: $
Course Prefix & Number: Credit Hours: Type: Fee: $
Course Prefix & Number: Credit Hours: Type: Fee: $
Course Prefix & Number: Credit Hours: Type: Fee: $
Total Fee Assessment: $
Exemption Types and Fee Assessment:
1. Exemption earned through Examination ($50)
2. Exemption earned through Portfolio (documentation of expertise) ($75)
STEP 4: Return form with paid receipt to PLA Evaluator. (if applicable)
Click here to print completed form, then sign and take to your appointment.