Petition Assessment Form

PETITION ASSESSMENT FORM (Prepare two forms for each petition one for each evaluator)

TO BE COMPLETED BY THE STUDENT Student Name: ID#:

COURSE PETITION: Prefix: Number: Title:

TO BE COMPLETED BY THE EVALUATOR

ASSESSMENT CONSIDERATIONS Please circle the following: (5) Strongly Agree, (4) Agree, 3) No Comment, 2) Disagree, (1) Strongly Disagree Course Prefix: 1-2-3-4-5 (a) Prefix coincides with the Title and Course Description. Course Number: 1-2-3-4-5 (a) Number is appropriate for the level of credit requested in the petition. Course Title: 1-2-3-4-5 (a) Title is descriptive of the course content. Course Description: 1-2-3-4-5 (a) The content of the course description is sufficient for the level of credit requested. 1-2-3-4-5 (b) The course description is adequately related to the student’s major. 1-2-3-4-5 (c) The course description is significantly different from others in the portfolio. Concrete Experience: 1-2-3-4-5 (d) The concrete experiences are adequate for the knowledge the student is claiming. 1-2-3-4-5 (e) The concrete experiences are related to the Course Description. Learning Outcomes: 1-2-3-4-5 (f) The learning outcomes are sufficient to support credit hours requested. 1-2-3-4-5 (g) The student adequately described WHAT was learned. 1-2-3-4-5 (h) The learning outcomes are related to the concrete experiences presented. 1-2-3-4-5 (i) The petition has an adequate balance between practical and theoretical knowledge. Applications and Implications for New Situations: 1-2-3-4-5 (j) Learning was applied to situations other than those in which it was acquired. 1-2-3-4-5 (k) Learning applies conceptually to future situations. Documentation: 1-2-3-4-5 (l) Documentation is adequate and supports the petition. General: 1-2-3-4-5 (m) Writing proficiency is adequate for the level of credit requested with this petition. 1-2-3-4-5 (n) Ability to express ideas was adequate for the level of credit requested in this petition.

RESULTS 1. ACCEPT The petition for credit as requested. (Comment below if desired) 2. DENY The petition for credit. (PLEASE COMMENT BELOW) 3. ADJUST The petition to reflect the following; (PLEASE COMMENT BELOW) Change PREFIX to: ______Change COURSE LEVEL to: (Please Circle) 1000 2000 3000 4000 Change TITLE to: ______Reduce HOURS REQUESTED to: (Please Circle) 1 2 3 Combine this petition with petition(s) ______and ______and call it: ______(Prefix) (Number) (Title) COMMENTS:

Evaluator’s Initials______