Xenia First Year Placement Evaluation Form

All fields with an asterisk (*) are required.

If any of the below information is not correct delays can occur in processing and notification.

Personal Information

Name *

What is your date of birth? *

Phone Number *

E-Mail *

Clark State ID Number *

What is your intended major?

What is your preferred campus for classes?

Are you a College Credit Plus (CCP) student? *

Have you taken the placement test within the past 30 days? If so, how many times? *
Please note there is a $15 retest fee after the first attempt.

Placement Testing Information

What areas of the placement test are you taking? *

Reading

Writing

Quantitative Reasoning

Advanced Algebra Functions

All areas

I’m not sure

If you were on an IEP/504 or received accommodations in high school or at another college: Would you like to receive accommodations for your placement test?
Please complete the Accommodation Request Form: https://elbert.accessiblelearning.com/s-ClarkState/ApplicationStudent.aspx

I understand and agree to the following statements.

1) An email confirmation will be sent to the address that I provided above. 2) Clark State may charge a fee for retests. 3) I will adhere to the policies of Clark State’s Testing Centers. 4) My request for a remote placement test may take up to two business days to process. 5) If I am more than 15 minutes late to my scheduled testing appointment, my test may be rescheduled.