Credit Recommendation Evaluation Form

First Name *

M.I

Last Name *

Banner Number *

Phone Number *

Street Address *

City *

State *

Zip Code *

PLA Credit Sought:

PLA Credit Sought: *

Equivalent course found on the PLA website-Crosswalks

Equivalent course for certification found on the PLA website - must attach copy of certification

Credit earned from portfolio evaluation ($300 fee paid when enrolled in the portfolio development course, PLA 1500)

Credit earned from a department challenge exam ($20 fee paid per semester hour;MUST pay fee prior to taking the exam-MUst attach a copy of the receipt

General education course, Social & Personal Awareness (SPA), for YSU sanctioned study abroad or matriculated international student (PLA 3700, 3 s.h.)

Note: If you are a veteran or active military or a dependent/spouse, most fees are waived-please inform the PLA Coordinator of status.

Date *

Student Signature

Course Description

Credit Hours

Catalog Number

Department

Faculty Member's Name/Signature (portfolio/challenge exam)

Faculty Member's Name/Signature (portfolio)

Department/College/Division

Department Chairperson Name/Signature (portfolio/challenge exam)

If the student is awarded PLA 2600 or PLA 3700 indicate how the credit hours apply toward the student's degree

Substitute for the following courses within major

Signature of PLA Coordinator

To be completed by the PLA Coordinator or a Member of the PLA Committee:

Approval Status

*PLA Coordinator or designee sends form to the Records Office (copy is maintained in the student's academic file and by the PLA Coordinator)

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