Mathematics Placement Appeal Cover Sheet
Name __________________________ Student Identification Number _____________
Address ________________________ E-mail: __________________________
__________________________ Phone #: ________________________
Program: _______________________
Original Mathematics Placement (from Placement Test) _______________ Date: _______
What was the last mathematics course that you took? When did you take it? Was it in college, or high school?
______________________________________________________________________
______________________________________________________________________
How well did you do?_______________________________________________________
________________________________________________________________________
What math course do you wish to begin taking at Clermont? ___________________________ Which quarter? ________
(not guaranteed)
Student’s Pledge:
I hereby affirm that all statements on this form are accurate.
I agree to allow the Mathematics Placement Coordinator to confidentially track my progress in mathematics courses at Clermont College.
______________________________________________ Date: ___________
(Student’s Signature)
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For Office Use Only:
Original Math Placement Test Score: ___________ Original Placement Course: ______________
Final Placement Decision: ___________________________________________
Approved by: ____________________________ Date: ____________________
**The best way to contact me is by email: Margaret.Hager@UC.EDU or mail completed cover sheet to:
Dr. Margaret Hager,
4200 Clermont College Drive,
Batavia, Ohio 45103,
Education Services Bldg. 215G
or fax the completed Cover Sheet to (513) 732-5304
Click here for Placement Test Menu