REASONS FOR EXEMPTION REQUEST
SIGNATURE REQUIRED
I understand that exemption is granted only after verification and institutional review.
Admissions Office
Assessment Testing Exemption Request
October 2017/PR
FOR ADMISSIONS OFFICE USE ONLY
Semester:
n
Fall
n
Winter
n
Spring
n
Summer Year: _____________
Exempt:
n
English and Math
n
English only
n
Math only
Signature __________________________________________________ Date: _____/______/_______
Copy sent to student
n
No
n
Yes Date Sent _____/______/_______ Initials: ___________________
Please complete this form. Sign, date, and submit to the Admission’s Office in SSC L156 with all necessary documentation. An Admissions staff member will review your request and
determine if you meet the requirements for exemption. Please be advised that if you are exempt from taking the assessment test, we strongly recommend that you see an academic
advisor for assistance with course selections. Please note: This exemption does not override prerequisites.
Please check all that apply.
Student Signature
n
I have achieved an appropriate score between 165-174 on the GED subtest Reasoning Through Language Arts
(RLA) and/or Mathematical Reasoning (MR).
n
I have achieved appropriate scores on the SAT/ACT exam and I am eligible to take a college-level English course
(see scores and check appropriate level).
n
I have achieved appropriate scores on the math portion of the SAT/ACT exam and I am eligible to take a college-
level math course (see scores and check appropriate level).
n
I have completed course work in a college-level credit English and/or math course with a grade of “C-” or better
at the following college/university/high school:
______________________________________________________________________________
n
I have taken the Accuplacer® English and/or math assessment test at the following college/university:
______________________________________________________________________________
n
I am age 62 or older.
ACT Scores:
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English: 21 for ENG* 101
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English + Reading: 47 for ENG* 101
n
Math: 18-21 for MAT* 138
Old SAT Scores (taken before March 2016):
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Critical Reading/Writing: 450 for ENG* 101
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Math: 500 for MAT* 109, 138
n
Math: 530 for MAT* 146, 148, 158, 165, 172
n
Math: 550 for MAT* 185, 186
n
Math: 650 for MAT* 254
New SAT Scores (taken March 2016 or later):
n
Reading Tests: 25 for ENG* 101
n
Writing and Language: 26 for ENG* 101
n
Math: 530 for MAT* 109, 138
n
Math: 570 for MAT* 146, 148, 158, 165, 172
n
Math: 620 for MAT* 185, 186
n
Math: 670 for MAT* 254
Date
STUDENT INFORMATION
First Name MI Last Name
Mailing Address
City State Zip
Please check only one. Exemption requested for
Banner ID Number Email Address Phone Number
n
New Student (never attended college)
n
Returning Student
n
Transfer Student
n
Mathematics
n
English
@
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