Human Services Summary Form

Summary of Prior Learning - Human Services

Students must consult with their mentor about the use of this summary. 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 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 as seen on 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 two copies of this form and two copies of any attached documentation to:
CDL Assessment Office, Empire State College, 113 West Avenue, Saratoga Springs, NY 12866.

Name:___________________________________________________________ESC ID:______________________


Phone (w)________________ (h)________________ Email Address:________


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:

The Human Service Agency    
The Human Service Profession    
The Human Service Worker    
The Environment of Human Service Delivery    
Service Provider and Client Interaction    
Crisis Intervention    
Human Service Policies    
Legal and Ethical Issues    
Case Management    
Community Organization and Education    
Supervision and Management    

1. List (or attach training documents for) any training programs you have taken that included human service topics. Give the approximate dates and length of each workshop/class/seminar.

2. Please describe the work and community experience that has involved human services. Include names of businesses, agencies, organizations, positions held/tasks performed, time of involvement.

3. What books have you read in the area? What journals do you subscribe to in this area?