Fillable form for payment.: Prior Learning Assessment and Recognition (Langara)

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form for payment.: Prior Learning Assessment and Recognition (Langara)

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The form for payment.: Prior Learning Assessment and Recognition (Langara) form is 2 pages long and contains:

  • 4 signatures
  • 4 check-boxes
  • 20 other fields

Country of origin: CANADA
File type: PDF

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STUDENT CHECKLIST
$150 for each course assessment.
To initiate a prior learning assessment and recognition, students must first consult with the
instructor to determine the eligibility of proceeding with an assessment. A signature from the
instructor confirming the consultation must be provided on this form in order to submit this
form for payment.
I have read the E2004 Prior Learning Assessment and Recognition policy.
Please find Faculty and Department grade submission instructions on the second page.
Page 1 of 2
Prior Learning Assessment and Recognition Request Form
REGISTRAR & ENROLMENT SERVICES
IMPORTANT INFORMATION
I have consulted the eligibility for proceeding with an assessment with the instructor on ___________________.
(YYYY/MM/DD)
PAID STAMP
Student’s signature
Date signed (YYYY/MM/DD)
Instructor (print name) Instructor’s signature
Date signed
(YYYY/MM/DD)
FACULTY INFORMATION
The fee for the Prior Learning Assessment and Recognition Request is non-refundable.
I understand and acknowledge that the assessment and decision by the faculty will be deemed final.
STUDENT INFORMATION
Langara ID:
Student name:
Complete the following and please print clearly:
Phone:
Email:
Course subject and number:
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Prior Learning Assessment and Recognition Request Form
REGISTRAR & ENROLMENT SERVICES
FACULTY CHECKLIST
TRANSFER CREDIT DEPARTMENT USE ONLY
Course subject and number:
Final grade assigned:
Assessment method used:
Assessment completion date (YYYY/MM/DD):
Eligibility confirmed?
Credit applied to student record on:
Yes
No
(YYYY/MM/DD)
Page 2 of 2
FACULTY & DEPARTMENT GRADE SUBMISSION INSTRUCTIONS
• Complete all required fields aer final assessment has been completed.
• Return form to Registrar & Enrolment Services office by email: transfercredit@langara.ca.
Note: Assessments that do not result in credit awarded do not need to be returned to Registrar & Enrolment Services.
Instructor (print name)
Department or Division Chair (print name)
Instructor’s signature
Department or Division Chair’s signature
Date signed
(YYYY/MM/DD)
Date signed
(YYYY/MM/DD)
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signature
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signature
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form for payment.: Prior Learning Assessment and Recognition (Langara)

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Completed 31 January 2021

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