The purpose of this exam is to identify the recommended class placement in the areas
of: Math, Writing and Reading for those planning to attend a state, community or
technical college. There is no fee. Students may also take the Accuplacer Exam on the
campus of the post-secondary program.
I would like to sign up (print student’s name):________________________________ for the
You may sign up for one or both dates. Please place an “X” next to the date(s) preferred.
ACCUPLACER Test Date: Return Sign-Up Sheet by:
_____ _January 29, 2013 January 22, 2013
______March 5, 2013 February 26, 2013
I grant permission for the Minnesota State Academy for the Deaf to administer the
Accuplacer Exam indicated by an “X” above to my student. I understand that if my student
does not show up on the test date indicated on this registration form, it will be the student’s
responsibility to re-register at a later time, or at another test location. If you have any
questions, please contact Paula Detjen , School Counselor at: firstname.lastname@example.org
or at 507-384-6637 voice.
Signature (parent/guardian if student is under 18 years of age):
Please return Sign-Up Sheet to:
Paula Detjen, MA, LMFT, LPC
Minnesota State Academy for the Deaf
615 Olof Hanson Drive
Faribault, MN 55021