General Information ( * Denotes a required field)

*Have you applied to the college and completed your admissions process and received a student number?
Yes No

If not, you must apply to the college before you can take the placement test. Please go to www.lcc.edu to apply.

*Have you taken the LCC placement test within the last two years?
Yes No

Have you taken the ACT, SAT, or TOFEL, or do you have a degree from another college or university? If yes, you may be able to receive placement levels through a waiver request. Click here for information on waivers and how to submit a waiver request.

What type of placement test do you need (Check all that apply)? Please be aware that math courses require reading and writing levels as well.

Reading    Writing    Math

What semester do plan on attending? Fall Spring Summer

Student Information

*Student Name      

*Student #                    SS#'s are not accepted.

*Birth Date      January Febuary March April May June July August September October November December       1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      

*Student Telephone     

*Student Address      

*Student City      

*Student State       International Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New York New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming

Note: If you are using an international address please select "International" as your Student State. Then type in your Country, State or Province below.

Country, State or Province: . 

*Student Zip/Postal code    

*Email Address            

*Verify Email Address    

*Semester Attending:     Fall Spring Summer

Proctor Information

If Proctor location is Livingston or Clinton Extension Centers only list as Proctor location.  No other proctor information is needed. 

*Proctor Name      (What's this?)

*Proctor Location 
 

*Proctor Address
 

*Proctor City     

*Proctor State       International Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New York New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming

Note: If you are using an international address please select "International" as your Proctor State. Then type in your Country, State or Province below.

Country, State or Province: . 

*Proctor Zip/Postal code     

*Proctor Email            

*Verify Proctor Email     

*Proctor Telephone     

 Proctor Fax     

*Have you used this proctor location previously? If yes, when?     

If your proctor charges a fee please list their fee in the box below

*Do you know the proctor on a personal or professional basis? 
Yes No

If yes,  Please explain. 

Do you require special testing accommodations, if so please explain. (Please note that documentation may need to be provided for your request)

Other Comments

ATTENTION:

The Online Testing Support Office will not process your request, unless the form is complete.

 The Online Testing Support Office requires seven to ten businesses days to process a request. You will receive an email notification once your request is processed.

 For additional information, please visit our website at www.lcc.edu/assessment

 If you have any questions or concerns, please contact our office at:

 1-800-644-4522 x5503 or by email at lcc_online_testing@lcc.edu