Page 1

FORM 1

(complete one form only) PORTFOLIO TITLE PAGE PORTFOLIO Presented to Instructor Name Presented by: Name of Student Student ID Program of Study: ______________________________________ Anticipated date of graduation: _________________

I hereby respectfully submit this portfolio electronically as part of the requirements for completion of the course POR300. I declare that I have written and organized the contents of this portfolio and that all of the information provided is accurate and true. Please complete below choosing ONE of the two options:

OPTION A I will be submitting the hard copy Portfolio to my advisor to challenge up to 27 credits. I understand that my Portfolio must be complete (including all of the required supporting documentation) and must be submitted to the POR300 instructor before the end of Term 1 Or

OPTION B I will NOT be submitting the hard copy Portfolio to challenge up to 27 credits. I have confirmed with my advisor that I don’t need to challenge additional credits through this Portfolio course to meet the OL Program’s credits requirement. I understand that I will not be able to change my option choice once my portfolio is submitted to my instructor.

Student Signature: __________________________

Date: _____

Cohort #____________________ Instructor’s Signature:______________________

Date:_____


FORM 2 (A)

Student version (complete one form only)

St. Thomas University Life Experience Portfolio Evaluation Checklist Name of student:_______________________ Program: _________________ Check ______

Portfolio Format 1. Portfolio is submitted according to required guidelines. (E.g. in a 3-ring binder, typed, double spaced, printed on one side only, on 8.5X11.5 white paper); and contains submission Forms 1-9. Submission Form

______

2. Is signed by student at time of submission and filled out completely; and the Title Page and Application Form clearly identify the course by name and number as well as the program of study toward which the credits are to be applied. Learning Outcomes Statements -- Skills and Knowledge

______ ______ ______ ______ ______ ______ ______

3. Include all positions or functions relevant to course being petitioned 4. List competencies or college level learning gained from work experiences or community activities. 5. Are concise and clear. 6. Stress current activities and/or in-service courses which were most beneficial 7. Are college level. 8. Explain why student believes he/she is eligible to receive credit for experiential learning. 9. Meet course requirements and match subject area as well as addressing all the major outcomes contained in each course outline. Documentation

_______ _______ _______ _______

_______

10. Documentation for each course outcome being petitioned is presented. 11. Has copies of original, signed letters on letterhead stationary describing time of employment and work responsibilities or community or other activities, where applicable 12. Includes photocopies of all other documents, i.e., no originals 13. If applicable, has one or two appraisals or work samples 14. Has extraneous material such as copies of diplomas, transcripts, awards or honors from college or other educational/training institution. Register and Pay for POR 400 15. Your portfolios will not be evaluated and the credits will not be posted to your AER and transcripts if you have not registered and paid for POR 400. 16. You must register and pay for POR 400 during the term immediately following the completion of the POR 300 course.

Recommendation of POR Instructor: S — satisfactory, has complied with most requirements SUBMIT PORTFOLIO

U —Unsatisfactory, has not complied with most requirements DO NOT SUBMIT PORTFOLIO

___________________________ Signature of POR Student

N/A — Not applicable DO NOT SUBMIT PORTFOLIO

_______________________________ Date


FORM 2 (B)

Assessor Version (complete one form only).

St. Thomas University Life Experience Portfolio Evaluation Checklist Name of student:_______________________ Program: _________________ Rating ______

Portfolio Format 17. Portfolio is submitted according to required guidelines. (E.g. in a 3-ring binder, typed, double spaced, printed on one side only, on 8.5X11.5 white paper); and contains submission Forms 1-9. Submission Form

______

18. Is signed by student at time of submission and filled out completely; and the Title Page and Application Form clearly identify the course by name and number as well as the program of study toward which the credits are to be applied. Learning Outcomes Statements -- Skills and Knowledge

______ ______ ______ ______ ______ ______ ______

19. Include all positions or functions relevant to course being petitioned 20. List competencies or college level learning gained from work experiences or community activities. 21. Are concise and clear. 22. Stress current activities and/or in-service courses which were most beneficial 23. Are college level. 24. Explain why student believes he/she is eligible to receive credit for experiential learning. 25. Meet course requirements and match subject area as well as addressing all the major outcomes contained in each course outline. Documentation

_______ _______ _______ _______

_______

26. Documentation for each course outcome being petitioned is presented. 27. Has copies of original, signed letters on letterhead stationary describing time of employment and work responsibilities or community or other activities, where applicable 28. Includes photocopies of all other documents, i.e., no originals 29. If applicable, has one or two appraisals or work samples 30. Has extraneous material such as copies of diplomas, transcripts, awards or honors from college or other educational/training institution. Register and Pay for POR 400 31. Your portfolios will not be evaluated and the credits will not be posted to your AER and transcripts if you have not registered and paid for POR 400. 32. You must register and pay for POR 400 during the term immediately following the completion of the POR 300 course.

Recommendation of POR Instructor: S — satisfactory, has complied with most requirements SUBMIT PORTFOLIO

U —Unsatisfactory, has not complied with most requirements DO NOT SUBMIT PORTFOLIO

___________________________ Signature of POR Assessor

N/A — Not applicable DO NOT SUBMIT PORTFOLIO

_______________________________ Date


FORM 3

(complete one form only)

St. Thomas University Student Agreement For Experiential Learning Assessment Students must submit all relevant information and documentation to the Director, STU Name:

Student No.

Address:

Email:

Postal Code:

Enrollment Status:

Home Telephone:

Business Telephone:

Program of Study

Date of Graduation (if applicable):

1. Faculty assessor may contact the student by e-mail or telephone to set up a time for a time and place for a personal interview, if needed. 2. Credit award is not automatic and the faculty assessor can only grant credit if the learning presented is judged to be equal to that of students regularly enrolled in that course. 3. Additional demonstration of learning or other activities (including verbal exam, interview, practical demonstration, reading assignments, attendance at selected class sessions or reports) may be requested of the student if a portfolio itself is inadequate. 4. Students requesting an assessment must register in an Assessment Seminar or POR 300 course and pay the appropriate fee. If credit is denied there shall be no refund. 5. There will be additional fees for re-submission of portfolio. 6. Faculty assessor may contact references or employers as named in the portfolio to verify sources. 7. All portfolios must be re-submitted within one year of its first submission. 8. Although the evaluation of portfolios will normally be completed in a few weeks, the administrative processes may prolong the actual reporting and transcription of the credit. 9. The student certifies that all of the information and documents provided in the portfolio are authentic, accurate and true. The student agrees that the application for credit will be denied if the information contained in the portfolio is falsified in any way. 10. The portfolio contains personal and confidential information and will not be shared with anyone other than the portfolio course teacher, assigned officials of STU, assigned faculty assessor, and his or her supervisor, without the prior written consent of the student. 11. Once faculty has assessed the portfolio and the student has been officially notified of the outcome of the assessment, the portfolio will be destroyed. I have read and understood the above information concerning the evaluation of my learning portfolio and agree to its conditions and requirements. Student's Signature Verification:

  

Date:

Portfolio (documentation, resume, letters of reference, transcripts, etc.) Challenge Exam  Interview Demonstration  Samples of work


FORM 4

(complete one form only)

St. Thomas University Application for Assessment Name: Student ID: Address: Graduation Date:

OL

Other: _________

_______________

HCS

Other: _________

Phone (Day):

Cohort #: ________

Phone (Eve):

Life Experience Portfolio Seminar completed:

Spring

Fall

Summer

YR: _______

I request approval to submit a portfolio to be evaluated for credits for the following course(s): Course Code

Course Name:

Credit hours Requested

I agree to pay any fee for the assessment of my Life Experience Portfolio due upon submission of this application. If paid, this fee is non-refundable, and subject to the period allowed for completion of the Life Experience Portfolio as stated in the Life Experience Portfolio Program requirements. Signature of Applicant: Date Paid:

Date:

Received by:


FORM 5

(complete one form only)

St. Thomas University Chronological Record Development Form Dates

Events

Make as many copies of this page as needed.


FORM 6

(complete one form only)

St. Thomas University Life Experience Portfolio Program ASSESSMENT RESULTS Name:

Student No.

Address (City, State, Zip):

Date Submitted:

Telephone Number:

Expected Graduation Date:

Program: ================================================================== For official use only FACULTY EVALUATOR RECOMMENDATION I hereby certify that I have evaluated the Life Experience Portfolio submitted by this student and make the following credit recommendations: Course Code

Course Name:

Credit hours Awarded

I recommend the above credit awards. Faculty Evaluator: _______________________________ Date: ___________ Comments:


FORM 7

(complete one form for each course you challenge for credits)

St. Thomas University Summary of Documented Learning (Use one form for each course challenged) This information provides you and the evaluator with an introduction to your learning. In the interview, the evaluator may ask you questions similar to those given in your petition for credit for prior learning outlined below. If necessary, you and the evaluator may agree on further methods of demonstrating your learning, including a written essay, a demonstration or performance, an examination, or a sample of your work. Please attach appropriate documentation to this form. This Form (#7) must be completed before you complete Form 8.

Name: _______________________________________________ ID # _______________________Cohort #________________ Address: _______________________________________________ Phone (w): ___________________ (h): ____________________ Email Address: _______________________________________________ Advisor: _______________________________________________ Anticipated Date of Graduation: _________________________________ Date of Submission: _________________________________ Name of Course: __________________________________________ Course Description ((From STU Course Calendar):


Course Learning Objectives Competencies ((From STU Course Syllabus):

HOW LEARNING WAS GAINED: 1. List the training programs you have taken in the subject/study area. Give the approximate dates and length of each workshop/class/seminar. This information is needed to verify and support your credit request. List them below and attach documents identified here at the end of Form 7. a) b) c) d) e) f) g)


2. Please describe in detail all work or volunteer experiences that relate to the STU course identified and named above. Include names of businesses, agencies, organizations; positions held/tasks performed; time of involvement. Your objective is to provide the faculty evaluator with an explanation of the experiences that have helped you learn about the topics covered in the particular course; include work, non-credit education courses or programs, community, volunteer, personal and other experiences

WHAT LEARNING WAS GAINED? 3. If someone asked you to do a Table of Contents for a book about what you know about this course, what would be listed? This list represents an overview of your knowledge about the course. a) b) c0


4. List the specific skills or competencies you acquired in learning about this subject? Using the eight “skill sets� below, describe some of the skills you have acquired as a result of learning about this particular subject. Complete as many as you can. i.

Describe how your communication skills have been enhanced as a result of learning about this subject (include oral, written, visual, presentation and listening).

ii.

Demonstrate how your interpersonal relationships have been enhanced as a result of learning about this subject.

iii.

Describe how you have enhanced your skills in group work and collaboration and your role as a leader and follower.

iv.

Describe how learning about this subject has enhanced your technological skills as they relate to the workplace.

v.

Describe how learning about this subject has enhanced your ability to use problem solving and critical thinking skills in your everyday life.

vi.

Describe how your understanding of this subject has impacted or changed your learning style and made you adapt culturally.

vii.

How has your knowledge gained in this course sharpened your decision making skills.

viii.

What impact did learning about this course have on your ethical or moral values?


5. How you have used (applied) the learning acquired above on the job or elsewhere? Give at least 2 examples: Example #1

Example #2

RESOURCES: 6. List any books or articles you have read, films/videos you have viewed, lectures given, papers written or works created on this subject. a) b) c) d) e) f) g)


7. Other--Please share any other information that will help the evaluator get an adequate appreciation of your understanding and expertise on this subject.

8. Please use Form 9 to list your supporting documents. (See pg. 31-35 in COLLEGE STUDENT GUIDE to Assessing Experiential Learning for a review on “documentation�. This guide can be found in the course documents section of BlackBoard. You will need to document all your experiences as described in items 1 to 7 above.


FORM 8

(complete one form only)

St. Thomas University Resume of Certified Learning Please complete all the fields in the “Resume Form� below, providing us with your Personal and Career Information (Mandatory). All information is confidential. Date:

Anticipated graduation date:

Employment and Certification Information Last Name

First Name and Initials:

Street address and City:

County/town, State

Email:

Present Position Title:

Tel. #:

# of persons supervised::

Fax. #:

Do you prefer to be contacted by:

Postal Code:

Email Phone Both Briefly give some reasons for wanting to receive credits for experiential learning:

State and describe your professional specialties or training:

Identify and list all your professional or clinical experiences (details of what you do or have done on the job):


Which type of professional license(s), certificate or affiliation(s) do you hold? Specify state, country (if other than the US) where you received them: Valid License or certificate (#1) (specify type): Valid License or certificate (#2) (specify type): Valid License or certificate (#3) (specify type): Valid License or certificate (#4) (specify type): Valid License or certificate (#5) (specify type): Valid License or certificate (#6) (specify type): Do you hold membership(s) in professional, cultural, social or community organizations? Name of organization (#1): Name of organization (#2): Name of organization (#3): Name of organization (#4): Name of organization (#5): Name of organization (#6): Please indicate the number of years you have worked full-time in your specialty or area of work: Less than 1 year 5-7 years

1 year

8-10 years

2 years

3 years

4 years

Over 10 years

Current Employment History (A): Name of institution

Type of institution:

Complete Street Address, City ++:

Describe major functions of institution:

Current Specialty:

Position Title:

Date Position Started:

Supervisor’s Phone:

Name Supervisor:

Supervisor’s FAX:

Supervisor’s Cell

May we contact supervisor for a reference?

Supervisor’s E-mail:

Yes

Please describe special job-related skills gained as a result:

No


Previous Employment History (B): Name of institution

Type of institution:

Complete Street Address, City ++:

Describe major functions of institution:

Current Specialty:

Position Title:

Date Position Started:

Supervisor’s Phone:

Name Supervisor:

Supervisor’s FAX:

Supervisor’s Cell

May we contact supervisor for a reference?

Supervisor’s E-mail:

Yes

No

Please describe special job-related skills gained as a result:

Previous Employment History (C): Name of institution

Type of institution:

Complete Street Address, City ++:

Describe major functions of institution:

Current Specialty:

Position Title:

Date Position Started:

Supervisor’s Phone:

Name Supervisor:

Supervisor’s FAX:

Supervisor’s Cell

May we contact supervisor for a reference?

Supervisor’s E-mail:

Yes

Please describe special job-related skills gained as a result:

No


Education Diploma/Certificate: (Date, name of program, academic institution, city, country):

Diploma/Certificate: (Date, name of program, academic institution, city, country):

Diploma/Certificate: (Date, name of program, academic institution, city, country):

Courses: (Date, Name of program, Academic institution, city, country):

Other: (Date, name of program, academic institution, city, country): Job-Related Courses –Identify courses which you have taken that are related to your job. Indicate dates received, names and locations where the course(s) were taken:

Other related Professional Memberships, affiliations, licenses, etc.:

Language ability: I speak and write English fluently I speak basic Spanish for job-related needs

My native language is English I speak and write French fluently I speak and write Spanish fluently

I also speak and write:

Work Experience—Please describe your work experience from the year you've started working as a (e.g. Lab Med Tech, Administrative Assistant, Office manager, Police Officer, etc.) to the present:

Resume— If you have prepared a resume, you may attach it to this Form 8 (optional).


FORM 9

St. Thomas University Life Experience Portfolio Program Index of Documentation Please list all transcript(s), certificate(s) or letter(s) from all colleges and training institutions attended or from sponsoring professional organizations. Photo copies must accompany this list. Name of Document

Description of Document

Resume— If you have a resume already prepared, you can attach it to this Form 8 (optional). Certification: By signing this application I authorize St. Thomas University or its authorized officials to verify the information and data I have provided and to have access to all my application files for credits for experiential learning. The information I have submitted on this form is correct and complete. I understand that failure to give complete and accurate information in this application could result in denial of credits. Furthermore, I understand that this application, nor any subsequent interview, is to be construed as creating a contract between STU and the applicant for either providing college credits or for providing any other benefit.

Signature: ________________________________ Date: ___________________


FORM 10 SAMPLE LIST OF COURSES OFFERED AT STU (that can be challenged for portfolio credits) REMEMBER THAT YOU CANNOT CHALLENGE COURSES THAT ARE PART OF THE Organizational Leadership mandatory CURRICULUM! These are samples. Replace with your own courses. 1. FIN 212 (Personal Financial Management) 2. COM 105 (Speech). (If your life or work experience qualifies you to challenge this course, it can be used as your Humanities requirement course for the OL program) 3. HCS 200 (Communication in Organizations) 4. HCS 215 (Leading people in organizations) 5. HCS 260 (Training Methods for Healthcare Managers) 6. BUS 120 (Principles of Business & Environmental Administration) 7. BUS 240 (Managing a Diverse Workforce) 8. BUS 250 (Business Communications) 9. SOC 411 (Death and Dying) 10. CRI (Criminal Justice) courses (CRI 302; 312; 321; 325; 405; 485)

por 300  

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