Generic Summary of Prior Learning Form

Generic Summary of Prior Learning Form

This information provides the evaluator with an introduction to your learning. In the interview, the evaluator will ask you questions similar to those given in the guide to grant credit for prior learning. If necessary, you and the evaluator may agree on further methods of demonstrating your learning, including a written essay, a demonstration or performance, an examination, or a sample of your work. Please attach appropriate documentation to this form.

You will be charged for your assessment of prior learning based on the IEF or IPLA fee structures detailed on www.esc.edu/fees. If your first matriculated enrollment was the January 2012 term or later, you may incur additional charges for the submission of Individualized Prior Learning Assessments (IPLAs). If your first matriculated enrollment was prior to January 2012, you must have paid the Individual Evaluation Fee (IEF) before this request can be processed.

Please submit this form in the Learning Essay Description section as an attachment to your Prior Learning Assessment request in PLA Planner.


Name:___________________________________________________________________

ESC ID#:_________________________________________________________________

Address:_________________________________________________________________

Phone (w):__________________________(h):___________________________________

Email Address:____________________________________________________________

Mentor/Advisor:____________________________________________________________

Please indicate if you are involved in any of the following CDL programs:

____AARP _____AT&T _____Lucent  _____United Steelworkers ____Army  _____Navy

Credits Requested:________

Level: Intro. or Advanced

Liberal Credit Requested:__________

Check the areas in which you believe you have competence. Identify whether you have an introductory or an advanced level of understanding.

Subject of Learning: __________________________________________

How learning was gained:

1. List (or attach training documents for) any training programs you have taken in the area. Give the approximate dates and length of each workshop/class/seminar.

2. Please describe relevant work or volunteer experiences. Include names of businesses, agencies, organizations; positions held/tasks performed; time of involvement.

What learning was gained: 

3. If someone asked you to do prepare a table of contents for a book about what you know about this topic, what would be listed?

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4. What competencies have you acquired in learning about this subject?

5. What challenges have you faced in learning about this subject?

Resources:

6. List any books or articles you have read about this subject (or other resources such as software or videos).

7. Please share any other information that will help the evaluator get a good sense of your understanding of this subject.

How to contact us:

If you have questions, please contact us at:

Assessment Office
Center for Distance Learning
Empire State College
113 West Avenue
Saratoga Springs, NY 12866
 
518-587-2100, ext. 3009 or 800-847-3000, ext. 3009
Fax: 518-587-2660