Case Management Summary Form

Summary of Prior Learning - Case Management

Students must consult with their mentor about the use of this summary form. This information provides the evaluator with an introduction to your learning. In the interview, the evaluator will ask you questions similar to those given in the Guide to Credit for Prior Learning. 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.

You will be charged for your assessment of prior learning based on the IEF or IPLA fee structures as seen on www.esc.edu/fees. If your first matriculated enrollment was January 2012 or later, you may incur additional charges for the submission of Individualized Prior Learning Assessments (IPLAs). If your first matriculated enrollment was prior to January 2012, you must have paid the Individual Evaluation Fee (IEF) before this request can be processed.

Please submit two copies of this form and two copies of any attached documentation to:
CDL Assessment Office, Empire State College, 113 West Avenue, Saratoga Springs, NY 12866.

---

Name:___________________________________________________________ESC ID:______________________

Address:____________________________________________________________

Phone (w)________________ (h)________________ Email Address:________

Mentor/Advisor:__________________________

Please indicate if you are involved in any of the following CDL programs:

____AARP _____AT&T _____Lucent _____United Steelworkers

____Army _____Navy

Credits Requested:________ Level: Intro. or Advanced Liberal Credit Requested:__________

Check the areas in which you believe you have competence. Identify whether you have an introductory or an advanced level of understanding.

Topic:	Introductory	Advanced
Case Management: Definition and Roles
Advocacy
Linking/Referral
Crisis Intervention
Individual Service Plan (ISP)
Daily Living Skills Training
Personal Values and Qualities
Financial Entitlements

1. List (or attach training documents for) any training programs you have taken that included case management topics. Give the approximate dates and length of each workshop/class/seminar.

2. Please describe work experiences that involved case management skills. Include names of businesses, agencies, organizations, positions held/tasks performed, time of involvement.

3. What books have you read in this area? What journals do you subscribe to in this area?