Fillable Placement Waiver Request 12-12-11

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Placement Waiver Request 12-12-11

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The Placement Waiver Request 12-12-11 form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Student Copy
Once you have received a waiver or results for all portions of the placement test, been accepted to the
College, and submitted immunization records, you may schedule an appointment for the next available
New START session to register for classes. Go to www.sunyorange.edu/advising and choose the
"New Student Advising" tab.
Student Name:
Date of Birth:
Maiden (Former) Name:
Mailing Address:
Student ID#: A ___ ___ ___ ___ ___ ___ ___ ___
City / State / Zip:
Telephone Number:
Signature:
Date:
Beginning Semester:
FA_____ SP______ SU_____
Placement Waiver Instructions (CHECK ALL THAT APPLY)
’
I am requesting to be waived from the
English
portion of the Placement Test based upon coursework
completed at:______________________________________________________________
A waiver from the English portion of the Placement Test will only be granted with proof of satisfactory
completion of Freshman English I with a grade of “C” (2.0) or better.
’ I am requesting to be waived from the
Math
portion of the Placement Test based upon coursework
completed at: _______________________________________________________________________
A waiver from the Math portion of the Placement Test will only be granted with proof of satisfactory
completion of any college-level Math course with a grade of “C” (2.0) or better.
*If it has been some time since you last took a math course it is recommended that you take the Placement Test to
determine your current math skills. However, if you choose to test, you will be held to that math placement.
*FOR OFFICE USE ONLY*
DO NOT WRITE BELOW THIS LINE
RESULTS
ENGLISH DECISION
:
Course/College:_____________________________________
APPROVED / DENIED –Reason: ___________________
__________________________________________________
INITIALS & DATE: _______________________________
MATH DECISION:
Course/College:____________________________________
APPROVED / DENIED - Reason: __________________
_________________________________________________
INITIALS & DATE: _______________________________
Based upon the information provided, the following decision in
regard to the Placement waiver has been made:
___ You are waived from having to take the Placement Test
___You must take the entire Placement Test.
___ You must take the Essay and Reading Comprehension
portions only.
___ You must take the Math portion only.
If you are required to take any part of the Placement Test
and need to schedule an appointment please visit:
wwww.sunyorange.edu/advising/assessment/testing_hours_appointments.shtml
115 South Street
Middletown, NY 10940
Tel: 845-341-4030
Fax: 845-342-8662
Placement Waiver Request
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Placement Waiver Request 12-12-11

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Completed 18 November 2019

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