EXPERIENTIAL LEARNING CREDITS REQUEST FORM
In accordance with existing policies and procedures concerning evaluation of certain nontraditional learning experiences, Columbia
Basin College may grant credit for successful completion of such experiences which may be applied toward the requirements for a
certificate/degree offered at CBC. Credit hours will be computed by the College in accordance with current evaluation and accreditation
policies concerning nontraditional learning experiences.
POLICY
Before a student can be granted credit for Experiential Learning and before the credit can become part of a student’s permanent
record, the student must satisfy all of the following conditions:
- Have earned 15 or more credits at CBC with a GPA of 2.0 or better and
- Enrolled at CBC during the quarter the credit is awarded.
Experiential Learning credit is granted only for classes that are regularly offered at CBC and approved by individual departments as
experiential learning-eligible courses. Please check with the program advisor for the current eligible courses before submission as
the courses are subject to change.
No credit will be awarded if the student has earned credit in a similar course.
Each request must be directed to the appropriate instructor who teaches the course or the department lead.
Credits awarded will be recorded with a “Pgrade and are specifically identified on the transcript as credits for Experiential Learning.
Up to one-fourth of the total credits required for a CBC associate degree or certificate or One-fourth of the minimum upper level
(300-400) course credits required for a CBC applied baccalaureate degree (Bachelor of Applied Science, Bachelor of Science in
Nursing) may be earned through the prior learning assessment.
Experiential Learning credits do not count toward the minimum CBC residency requirement.
A course completed by experiential learning credits is not eligible to fulfill general education requirements.
An appropriate designee will determine that a student has adequately demonstrated competency of a course within 6 weeks after
all application materials are received (i.e., Section 2 is completed).
Complete all sections in sequential order.
SECTION 1: TO BE COMPLETED BY STUDENT
1. Contact the Dean’s office to identify the appropriate designee.
2. Make an appointment with the designee and discuss Experiential Learning evaluation process.
3. Complete this section.
Name: Student ID Number:
Quarter/Year requesting Experiential Learning credits:
Summer Fall Winter Spring Year ______________
Current cumulative CBC GPA:
I request credits for Experiential Learning in:
______________________ _______________________________________________________ _______________
Course ID (e.g., ENGL& 101) Course Title Number of Credits
Name of Faculty discussed Experiential Learning credit eligibility: Date of the discussion:
I understand the above policy and request my experiential learning credit assessment.
__________________________________________
Student’s Signature
_____________________
Date
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SECTION 2: TO BE COMPLETED BY STUDENT
1. Complete the Experiential Learning Portfolio (see the Guideline included in the form).
2. Pay the non-refundable fee to Hawk Central and attach receipt to this form.
3. Submit the portfolio to the appropriate designee.
SECTION 3: TO BE COMPLETED BY APPROPRIATE DESIGNEE
1. Evaluate the Experiential Learning Portfolio. Contact the student if additional information and/or clarification is needed.
2. Complete this section to indicate the approval decision.
3. Submit the form to the Dean. DO NOT return the form to the student for processing.
Course Requested
(e.g., ENGL& 101)
Credits Approval Decimal Grade Evaluation Methodology/Reason for Disapproval
Yes
No
I certify the student has shown competence and knowledge for the course approved above at a performance level of a 2.0 grade
point minimum and has earned the grade of P.
___________________________________ ___________________________________ ________________
Instructor/Designee Name Signature Date
SECTION 4: TO BE COMPLETED BY DEAN
1. Sign the form for final approval.
2. Submit the signed form to Student Records (Mail Stop: H4)
I certify the student has met the Experiential Learning credit requirements and authorize ______ credits be posted on the
transcript with a grade of “P”.
___________________________________ ___________________________________ ________________
Dean Name Signature Date
SECTION 5: TO BE COMPLETED BY REGISTRAR
___________________________________
Registrar Name
___________________________________
Signature
________________
Date
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and affirmative action. CBC does not discriminate on the basis of
race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or
military status, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or
employment. Questions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individuals with disabilities are encouraged to participate in all
college sponsored events and programs. If you have a disability, and require an accommodation, please contact CBC Disability Support Services at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is
available in alternative media by request
Rev Aug 2020
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EXPERIENTIAL LEARNING PORTFOLIO REQUIREMENTS
Item Title Specifications
Title Page
Title, Your name, Program name, Quarter/Year you started the program at
CBC, Date of submission.
Table of Contents
A chronological listing of the items in the portfolio w/ page number.
Form
A completed Experiential Learning Credit Form.
Introduction
A brief statement (Max. 1-pg) about yourself, your ideas or expectations
related to the portfolio, and/or any directions on how you want the
reviewing team to read the portfolio.
Goals
Essay (Max. 2-pg.) stating your educational/professional goals.
Work Experience
Resume
Credit Summary
History of the program relevant courses taken in the past (even if the
credits did not transfer) with year and institution. The courses must
appear on the unofficial transcript(s).
Self-analysis of
Learning
Main section of the portfolio. Narrative analysis and listing of supporting
evidence for each student learning outcome of the course being
petitioned for experiential learning credits.
Documentation
A list of evidence documents. Varies by program and individual
background. Examples include but are not limited to:
Letter(s) of recommendation from an individual who is qualified to verify
the knowledge/skills acquired
Unofficial college transcript showing the completed courses
Industry certificate and/or license
Published work
Audiovisual presentation
Certificate of completion
Awards and/or recognition
Writing sample
Proposal sample (must be first-authored)