Prior Learning Assessment: Self-Assessment Form (Page 3 of 3) in pdf

Prior Learning Assessment: Self-Assessment Form Page 3

Prior Learning Assessment Waiver

This signed waiver gives permission to the Assessor to contact employers, co-workers, or references

named in my portfolio, on my resume or below in order that the sources of my documentation can be

verified.

Name (please print):_____________________________________________

Sheridan Student ID number (if applicable):___________________________

As per Section 39(1) of the Freedom of Information and Protection of Individual Privacy Act (FIPPA),

I,___________________________________________, authorize Sheridan to contact the persons or organizations

listed below to obtain reference information.

1. Name of Organization

Phone: Day

Contact:

Evening

Title:

Relationship to Reference:

2. Name of Organization

Phone: Day

Contact:

Evening

Title:

Relationship to Reference:

3. Name of Organization

Phone: Day

Contact:

Evening

Title:

Relationship to Reference:

Signature:_____________________________________________________

Date:_________________________________________

Prior Learning Assessment: Self-Assessment Form Page 3