Please complete the following form and submit to the Student Services Office, with required documentation . An
Enrollment Services Staff member will determine if you meet the requirements for exemption. If you are exempt from assessment testing, you are strongly encouraged to meet with an advisor prior to course selection.
NAME:
BANNER ID ( REQUIRED FOR PROCESSING ): @
PHONE #:
EMAIL:
CHECK ONE: New Student to QVCC Continuing Student Re-admitted Transfer Student
I AM REQUESTING AN ASSESSMENT TESTING EXEMPTION FOR: MATH ENGLISH BOTH
REASON FOR REQUEST:
SAT EXAM : Critical Reading or Writing score of 450 or higher (Placement in ENG* 101 ); and/or a
Math score of 500-549 or higher (Placement in MAT* 137) , a Math score of 550 or higher (Exempt from MAT* 137 – See Advising).
( SAT scores must be provided ).
ACT EXAM : English score of 21 or higher or an English and Reading score of 47 or higher (Placement in ENG* 101 ); and/or a Math score of 18-21 or higher (Placement in MAT* 137) , a Math score of 22 or higher (Exempt from MAT* 137 – See Advising).
( ACT scores must be provided ).
College credit for English and/or Math through the College Careers Pathway Program (Tech Prep), or through an AP Placement Exam ( Unofficial transcript or College Board test results must be provided).
College-level English and/or Math credit with a grade of C- or higher (Unofficial transcript must be provided). Name of Institution:
Assessment test(s) at another CT Community College or Institution ( Evidence of test scores must be provided ).
Name of College: .
I am 62 years old, or older
____________________________________________________________________________________________________________
FOR OFFICE USE ONLY:
ACCUPLACER English Student is Exempt Not exempt
English Placement
ACCUPLACER Math Student is Exempt
Math Placement
Not exempt
Revised JAN-2012