PORTFOLIO WORKSHEET AND ASSESSMENT EVALUATION FORM FOR LEAP CREDIT
Please Print:
Student’s Name Student ID #
Address City/State/Zip
Telephone # Completion Date
INSTRUCTIONS:
You have received a course description and a list of competencies/objectives for each of the courses for which you are seeking credit. Use these lists to reference your acquired competencies and include these lists in your portfolio. You may also attach a list of alternate competencies if they are appropriate to the course description. Remember that a DEMONSTRATION of competencies acquired is also required if LEAP credit is being requested for work experience; a demonstration is not required for structured course work from other institutions. To receive credit for a course, it must be demonstrated that you have acquired a minimum proficiency of 75% in the competencies listed for the course or for approved alternate competencies listed.
Attach as many sheets as is necessary to cover all of the competencies:
TO BE COMPLETED BY THE STUDENT |
TO BE COMPLETED BY THE COMMITTEE |
Course Number |
Credit Hours |
Competencies Acquired (Reference to Lists) |
Type of Documentation (Code* at Bottom) |
Documentation Approved ______________________ Yes No |
Demonstration Approved ____________________ Yes No |
Credit Recommended ______________________ Yes No |
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Committee Signatures:
Faculty: ___________________________________________________ Date:______________________
Division Dean: _____________________ __________________________ Date:______________________
Registrar’s Representative:_____________________________________ Date:______________________
Additional Expert: ___________________________________________ Date:______________________
Upon completion of evaluation, the Division Dean should complete an Application for LEAP Credit (Form 1435/002) and forward to the Registrar’s Office.
Documentation Codes:
A - Awards L - Licensure / Certifications
C - Course Content/Description (Credit or Non-credit) and Contact Hours N - Narratives of Experience
D - Drawings, Diagrams, Artwork, etc. O - Other
E - Work Experience, Job Description, etc. R - Letters of Recommendation / Testimony
G - Graduation Certificates T - Transcripts
H - High School Co-op Work Experience Training Plan Form 1435/001 (7/07)