Placement Test Referral Form Building 7, Room 313 Session No. _____________
Date: ___________________
PICTURE ID REQUIRED
Student’s/Applicant’s Name:
Print Last Name First Name Middle Initial
Date of Birth: _________________________ Banner ID Number: _________________________
[ ] Applicant may take the placement test (processing application or expired test scores) at no charge.
[ ] Retest – Student is subject to a $25 retest fee per test session.
Placement Test: [ ] English Only [ ] Math Only [ ] English & Math
[ ] English as a 2
nd
Language
[ ] I am not currently enrolled in a English course. [ ] I am not currently enrolled in a Math course.
Applicant’s Signature: _______________________________________________________________________
Counselor’s/Clerk’s Signature: __________________________________________ ext. __________________
Placement Testing – Honolulu Community College
The College Skills Center provides testing for University of Hawaii students who wish to retake the placement
test.
• There is a $25.00 per sitting fee for the test proctoring service. NO REFUNDS.
• Tests will be administered only after all fees have been paid
Procedure to Retest:
1. Have an Academic Counselor (Building 5) verify that this is a placement retest and obtain a Placement
Test Referral Form (must be signed by an Academic Counselor). When you are ready to take the test,
have the Registrar (jstenber@hawaii.edu) assess the test fee.
2. Go to the HCC Business Office (Building 6), at the service counter to pay the $25.00 retest fee. Fees
must be paid by check, cash, or debit card before going to the testing center.
3. Go to the Testing Room in Building 7, Room 313 to retake the placement test during placement testing
hours.
Bring: a. Placement Test Referral Form with evidence of payment
b. Picture ID
ADMISSIONS OFFICE USE ONLY
Date Fee Assessed: _________________
Fee Collected By: ________________
Name: ___________________________
Date: ____________________________
Rev. 20200804
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