COMPASS/ESL Placement Test Remote Site Registration Form NOTE: Student must have completed an application to the College prior to submitting Remote Site Registration form. Complete this form and e-mail to Compass@cscc.edu Date: Name: Last First Middle Initial Date of Birth: M/D/YYYY Mailing Address: Street City State Zip Code Telephone Number: Primary Secondary E-mail Address: Cougar/Student ID #: (Note: This is NOT your SSN) 7-digit number Location for testing: College/University or ACT Testing Center Address City State I have a high school or home school diploma I am still in high school or home school program Zip Code I have a GED I do not have a GED or high school diploma 1. Have you applied to Columbus State Community College? Yes No 2. Is American English your native language (learned in the United States)? Yes No 9 10 If Yes, answer questions 5 through 7. If No, answer questions 3 through 7. 3. In what country did you learn English? 4. Select EACH grade you completed in an American school system: 1 2 3 4 5 6 7 5. Have you taken the ACT test within the past 2 years? Yes No 6. 8 11 12 If Yes, you can submit your ACT scores in place of one or more parts of the COMPASS test. ACT cut scores must be met in English (18), Reading (21), Math (22). Access your scores at www.actstudent.org and e-mail to Compass@cscc.edu. Do you have transfer credit for English and/or Math from a previous college? Yes No If Yes, you must submit a copy of your college’s transcript/grades to tgoetz@cscc.edu. 7. Have you taken English and/or Math classes through Columbus State? Yes No COMPASS Test Mode: Date Received/Staff Initials: Revised 06/30/2014 W ESL E-Write CS CC St af f M ESL R/G R On l y RETEST Date Processed/Staff Initials: W M R