Test Form by HC12062518425


									                      Department of Mathematical Sciences (DMS)
Application for Math Placement Examination Form
** There is an $11 fee assessed for taking the DMS Placement Exam **
                                                                   Student Information
 Name:                                                                                  Date:
 Student ID:                                                                            Major:
 Phone:                                                                                 Email:

                                           Information (please check each box to acknowledge)
      The exam only allows placement into UNLV MATH 120, 124 and 126 (or allows higher level placement testing*)
      The exam fee is $11
      The fee is only allowed for the date provided below
      The fee is non-refundable (even if I am not eligible to take the test, cancel, reschedule, or fail to show)
 * In order to place into higher level courses (i.e. MATH 132 and MATH 181) a student must first successfully complete this placement exam. A
   proper score on this exam will allow the student to take an exam specifically tailored to their course of choice, for no additional fee.

                                                     Eligibility** (please check all that apply)
      I have not taken SAT -or-                  I have taken SAT, and wish to better my placement. If so, report score:
      I have not taken ACT -or-                  I have taken ACT, and wish to better my placement. If so, report score:
      I have not taken the UNLV DMS placement exam within the last month
      I have not previously taken a math course from a NSHE institution (such as CSN, NSC, etc.)
      I have not transferred a math course from an accredited college or university
 ** It is the students’ responsibility to determine eligibility or seek clarification. While it may be possible for an ineligible student to sign up, pay for
   and take the placement exam, the fee will not be refunded, and the exam score will be inadmissible and will not be uploaded into the system.

                                                    Steps to take the Math Placement Exam
 Date of Exam:                                                           Location of Exam:
 STEP 1: Pick up this form from the DMS front office (CDC Building 8) or download online.
 STEP 2: Present this form to the Cashier’s office in SSC room 131 and pay the $11 fee.
 STEP 3: Take this form and receipt of payment to the DMS front office (CDC Building 8).
 STEP 4: On the date of the exam listed above, come to the location provided above with a government issued id or
    rebel card, and pencil. Electronics (such as cell phones, calculators, etc) and backpacks will not be allowed in the
    testing facility.


 Student Signature                                                                                                                   Date

                                                            ** For Department Use Only **

 Math Department Acct.             # 2220-260-6524-78-19

 Processor Name                                                     Processor Signature                                              Date

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