Prior Learning Assessment: Self-Assessment Form Page 2
ADVERTISEMENT
1
2
3PRIOR LEARNING ASSESSMENT APPLICATION
Please include the $110.64 (non-refundable) assessment fee with this application. Attach all supporting documents such as
portfolio, letters, résumés, etc. that apply to your request.
Full-Time
FCAPS
Student Number
Mr.
Surname
Given Names
Date of Birth (mm/dd/yyyy)
Mrs
Street Number and Name,
Apt. No.
P.O. Box, R.R. #
City/ Town
Prov.
Postal Code
Home Phone
Cell Phone
Email (Sheridan applicants and students:
If you are applying for postgraduate Nursing credits, please include your
we will
)
REGISTERED NURSING ONTARIO CERTIFICATE OF COMPETENCE NUMBER
communicate via your Sheridan email account
Course Title
Subject Code
Catalogue Number
Class Number
Program:
Source of Learning
Work Experience
Volunteer Work
Self Study
Seminars, etc.
Other:________________________________________________
Signature of Applicant _________________________________________________ Date ______________
FOR OFFICE USE ONLY
Approved:
Yes
No
Grade _____________ Entry Date _____________ Specialist’s Signature____________________________________
Assessor’s Name (please print)
Assessor’s Signature
Date
__________________________________
__________________________________
______________
Coordinator’s Name (please print)
Coordinator’s Signature
Date
__________________________________
__________________________________
______________
Information Acquired from the following sources:
Interview
Portfolio (documentation)
Challenge Exam
Samples of work
Demonstration
Other ________________________________________________
Assessor’s comments _____________________________________________________________________________________
_________________________________________________________________________________________________________
Payment received by: _________________________________________________________________________________
Freedom of Information and Protection of Privacy Act, 1987. The information on this form is collected under the legal authority of the Colleges and Universities Act, R.S.O. 1980,
C.272, s5: R.R.O. 1980, Reg. 640. This information will be used for the purpose of making admission and registration decisions, for communicating additional information about
College-wide activities, and for administrative and statistical purposes of the Ontario Ministry of Education and Training: For further information, please contact the Office of the
Registrar.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business