FOR ADMISSIONS OFFICE USE ONLY
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High School Partnership Program
Assessment Testing Exemption Request
Please complete this form. Sign, date, and submit to the Admissions 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.
STUDENT INFORMATION
First Name MI Last Name
Banner ID Number Email Address Phone Number
Mailing Address
City State Zip
Are you a new student (never attended college)? Exemption requested for
n
Yes
n
No
n
Mathematics
n
English
REASONS FOR EXEMPTION REQUEST
Please check all that apply.
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).
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 previously taken the Accuplacer® English and/or math assessment test:
SIGNATURE REQUIRED
I understand that exemption is granted only after verification and institutional review.
ACT Scores:
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English: ≥ 21 for ENG* 101
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English + Reading: ≥ 47 for ENG* 101
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Math: 18-21 for MAT* 138
New SAT Scores (taken March 2016 or later):
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Reading Tests: ≥ 25 for ENG* 101
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Writing and Language: ≥ 26 for ENG* 101
n
Math: ≥ 530 for MAT* 109, 138
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Math: ≥ 570 for MAT* 146, 148, 158, 165, 172
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Math: ≥ 620 for MAT* 185, 186
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Math: ≥ 670 for MAT* 254
Student Signature
Date
Semester:
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Spring Year: _____________
Exempt:
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English and Math
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English only
n
Math only
Signature __________________________________________________ Date: _____/______/_______
Copy sent to student
Date Sent _____/______/_______ Initials: ___________________
March 2020/PR
n
Fall
n
No
n
Yes
