For Single Course, 12-week PLAs

Center for the Assessment of Learning
Thomas Edison State College • 101 W. State St. • Trenton, NJ 08608-1176

Check one:
I am currently enrolled in Thomas Edison State College.
I am not currently enrolled in Thomas Edison State College.
      Current institution:


Please select the semester you plan to take your PLA:*


Last Name:* First Name:* MI:
Street Address:*
City:* State:* ZIP Code:*
College ID Number:
(if TESC)
  Daytime Telephone Number:*
E-mail Address:*

Have you completed English Composition I and II (ENC-101 and ENC-102)?**
No Yes

** Students are strongly advised to complete English Composition I and II before registering for Prior Learning Assessment (PLA). PLA may not be done for physical education courses, field experience, student teaching, cooperative study, practicums, English Composition I and II, current independent study, internships, seminars, lab courses or other courses whose subject matter may be inconsistent with demonstrating prior learning through a narrative-centered e-portfolio process.

This proposal form is to be submitted at least two weeks prior to the close of the registration period for the semester requested.

Please indicate the primary reason for your interest in Prior Learning Assessment (PLA):
pursuing a degree at Thomas Edison State College
(note degree program in which you are enrolled)
pursuing a degree at another institution
(please name)
Non-degree seeking student banking credits for teacher certification or professional advancement
other

ALL STUDENTS MUST READ AND ACKNOWLEDGE THE FOLLOWING*:

I acknowledge that the information I submit to Thomas Edison State College on this form and in my PLA courses is true and correct. I understand that willful failure to give accurate information is considered adequate grounds for dismissal from the College and for revocation of credits granted.

Thomas Edison State College is committed to providing reasonable accommodation for verified disability. If you would like information on reasonable accommodation for disability, please contact the ADA coordinator at (609) 984-1141, ext. 3415 (voice), (609) 341-3109 (TTY).

COMPLETE SECTION I OR SECTION II BELOW.* THEN COMPLETE SECTION III.

I. If the portfolio you plan to complete as a PLA portfolio appears in the Thomas Edison State College PLA Course Description Database, please provide the following information:

a. Course Title: 
b. Course Code/number: 
c. Credits (semester hours):

II. If the portfolio you plan to complete as a PLA portfolio does not appear in the Thomas Edison State College PLA Course Description Database, you may select a course description from another regionally accredited college. The description from that College’s catalog should be no more than two years old.

a. Course Title:
b. Course:
c. Credits (semester hours):
d. Name of the college where you
found the course description:
e. Year the catalog was published:
f. Page on which the description appears or link to the description:
g. A copy of the course description:

III. Briefly describe the experience you will bring to your PLA portfolio. This will be reviewed for approval. Before completing this form, make sure to read and carefully consider the PLA Self Assessment Guide. This information is designed to help you determine, before your register, whether your prior learning is appropriate for this method of earning credit.*


THIS IS NOT A REGISTRATION FORM. By submitting this form to the Office of Learning Assessment, you are declaring your intent to develop an Individualized PLA Portfolio. You will be informed when you are cleared to register, at which time you may contact the registrar by fax or phone using the College’s Course Registration Form. STUDENTS MAY NOT REGISTER ONLINE FOR INDIVIDUALIZED PLA COURSES.

* Required Field