Request for Prior Learning Assessment (
PLA
)
To submit this form:
Email: jschofield@newriver.edu | Fax: 304-929-6719 | Mail: 280 University Drive, Beaver, WV 25813
Instructions for Students: Complete and submit this request to the Registrar’s Office, along with any necessary
supporting documentation.
Name: Student
ID
#
Last, First Middle
Email: Phone Number:
I request assessment for prior learning as indicated below. I have read and understand the general policy
for Credit for
Prio
r
Learning as outlined on the New River
CTC website,
and understand that
payment
of fees
is
nonrefundable
and does not
guaran
t
ee
award of credits. I
furth
e
r
understand
that credit awarded will be
posted to my transcript at the end of the grading period in
which
approval is
grant
ed. By typing my name
below, I understand and agree that this form of electronic signature has the same legal force and effect
as a manual signature.
Student Signature
Date
Posted by Registrar (signature)
Date
CC: Dean of appropriate department.
Business
Office Use
Only
Date Paid:
_________
Initials:
_________
o Advanced Placement (AP)
o Armed Forces – Military Credit
o College Level Examination Program (CLEP)
o Challenge Exam for the following course(s):
Assessment Fee: $35
Challenge Exam: $75 per course
o Portfolio Assessment for the following Course(s):
Assessment Fee: $35
Portfolio Fee: $75 per course
o Certification or Licensure
Type of Certification or Licensure to be reviewed:
Assessment Fee: $35
Certification/License Evaluation Fee: $75
Faculty Assessor Signature
click to sign
signature
click to edit
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