Fillable Self-Report Form Please complete the following placement tables (Leeward Community College)

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Self-Report Form Please complete the following placement tables (Leeward Community College)

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Self-Report Form
Please complete the following placement tables below so that Leeward CC can place you in the right English
and Math courses based on your academic background.
1. Last name, First name: _________________________________________
2. UH Student ID Number: ________________________________________
Note: Self-reported score does not guarantee placement. Please see an Academic Counselor to determine if your
scores can be used.
Directions: Please fill in each box in the placement table to the best of your ability. Check the N/A column
if it is Not Applicable to you. Once completed, please return form to lrecruit@hawaii.edu
ENGLISH:
What language(s) are you most comfortable speaking: __________________ and writing: _____________________?
Score/Grade/GPA
Test Date or Grad
Date
N/A
My ACT English score is
My English SAT Evid. Based Reading/Writing score
is
My Smarter Balanced English Ach Level is
My Language Arts Writing HiSET score is
My Reasoning through Language Arts GED score is
My 12
th
grade English course grade is
My Cumulative High School GPA is
MATH:
Score/Grade/GPA
Test Date or Grad
Date
N/A
My Math ACT score is
My Math SAT score is
My Smarter Balanced Math Ach Level is
My Math HiSET score is
My Mathematical Reasoning score on the GED is
My Algebra I grade is
My Algebra II grade is
My 12
th
grade STEM Math Class Algebra III grade is
My 12
th
grade STEM Math Class Trigonometry grade
is
My 12
th
grade STEM Math Class Calculus grade is
My 12
th
grade Intro to College Math grade is
My Cumulative High School GPA is
To the best of my knowledge, I confirm by signing below that the placement information provided above
is the most accurate placement information to date.
_________________________________________ _________________________________________
Signature Date
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Self-Report Form Please complete the following placement tables (Leeward Community College)

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Completed 7 September 2020

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