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?
Yes
No
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:
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Month
-
Day
Year
Date
EVIDENCE RECORD FORM RPL Officer to Complete
Name:
Student ID:
Course for which applicant is seeking RPL/Credit Transfer:
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Applying for
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
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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:
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Month
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Day
Year
Date
Date Completed:
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Month
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Day
Year
Date
Comments, if any
Evidence attached
Yes
No
Comments, if any
Signature of Applicant
Date:
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Month
-
Day
Year
Date
RPL and/or Credit Transfer Facilitators Signature
Date:
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Month
-
Day
Year
Date
Academic Manager's Signature
Date:
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Month
-
Day
Year
Date
Note:
Total enrolled hours must equal course hours minus Credit Transfer hours.
Students must be enrolled in all units/modules of the course.
A copy of the form to be attached to the student's timetable, delivery and assessment plan.
A copy of the form and evidence to be held in the student file for two years.
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