Credit Transfer Application Form

RPL and Credit Transfer Application Form
Student Details
Name:
Student ID:
Current Address:
Course:
Have you provided all relevant evidence / documents for the RPL and/or Credit Transfer?
Grounds RPL and/or Credit Transfer
Please write why you believe your RPL and/or Credit Transfer application should be assessed? Attach an additional sheet if needed. Provide all the required evidence of prior learning and complete assessment process as set out by your RPL assessor.
Student Signature:
Date:

MonthDayYear
Date
EVIDENCE RECORD FORM RPL Officer to Complete
Name:
Student ID:
Course for which applicant is seeking RPL/Credit Transfer:

Applying for

Rows	Units of Competency Code & Name	Description of Evidence Presented and Reviewed. All the originals must be sighted for verification purpose	Credits Granted: Full/Partial
1
2
3
4
5
6

Declaration: RPL and/or Credit Transfer Facilitator has verified the competencies through the evidence presented which may include Academic Transcripts, Awards, Work Certificates and/or evidence of general life experiences.
RPL and/or Credit Transfer Facilitator Name:
Applicant's Name:
RPL and/or Credit Transfer Facilitator to verify sighting of original or certified copies of Statement of Results or Statement of Attainment or Qualifications as evidence.
Date started:

MonthDayYear
Date
Date Completed:

MonthDayYear
Date
Comments, if any
Evidence attached
Comments, if any
Signature of Applicant
Date:

MonthDayYear
Date
RPL and/or Credit Transfer Facilitators Signature
Date:

MonthDayYear
Date
Academic Manager's Signature
Date:

MonthDayYear
Date
Note:
1. Total enrolled hours must equal course hours minus Credit Transfer hours.
2. Students must be enrolled in all units/modules of the course.
3. A copy of the form to be attached to the student's timetable, delivery and assessment plan.
4. A copy of the form and evidence to be held in the student file for two years.
RPL and Credit Transfer Application Form Ver 1 | Heaton Institute of Technology | 03 9961 7512 & 03 9961 7482 | info@hit.edu.au | www.hit.edu.au
364-372 Lonsdale Street, Melbourne, 3000, Victoria, Australia | Page 2 of 2
Should be Empty:

RPL and Credit Transfer Application Form