In Partnership with
 

Ottawa Campus:
85 O'Connor Street, Ottawa, ON
(613)233-1128

 

PLA Application Form

Completing and submitting this form is the first step in the PLA Process. It is often done with the Counselor.

Personal Information:
 
Name:_________________________________ Date:_______________________
 
Address:_______________________________  
              _______________________________  
              _______________________________  
 
Telephone:______________________________  
 
Current Work Information:
 
Company/Gov. Dept.: ___________________ Job Designation: __________________
 
Job Title:_____________________________ Authorizing Manager: ______________
 
Work Tel.:____________________________ Manager’s Tel.: __________________
 
  Manager’s Email: _________________
 
Program Information:
 
Which program do you wish to use the PLA Process for to receive credits (Example: e-Business
Enterprise Developer)?
 
___________________________________________________________
 
 
 
Give a brief summary of your life long learning that supports you have acquired some of the skills
and knowledge in this program:
 
_______________________________________________________________________________________________
 
_______________________________________________________________________________________________
 
_______________________________________________________________________________________________
 
_______________________________________________________________________________________________
 
 
Signature:__________________________________