English Placement Test (EPT) Exemption Form

English Placement Test (EPT) Exemption Form I believe I have satisfied the EPT requirement in one of the following ways: ☐ by completing equivalent college-level coursework (a transcript must accompany this form). Name of College: ________________________________________________________________ Name of Course: ________________________________________________________________ Grade Earned: __________________________________________________________________ ☐ by earning the necessary SAT or ACT test score (a test score report must accompany this form). SAT (500 or above on the Critical Reading Section) Score: ____________________________ Test Date: _____________________________ ACT (22 or above on the English Test) Score: ____________________________ Test Date: _____________________________ ☐ by earning the necessary AP test score (an official copy of AP test scores must accompany this form). AP (3 or above on the English Language and Composition Test Score: ____________________________ Test Date: _____________________________ AP (3 or above on the Composition and Literature Test) Score: ____________________________ Test Date: _____________________________ ☐ by earning the necessary “Standard Exceeded” on the CAASPP EAP exam (an official copy of the test score must accompany this form). Attached is a copy of my test score report and/or transcript as verification of my exemption. As the documents being submitted with this form are unofficial, I certify that the information is true and accurate. My signature on this form indicates that I understand that I will be subject to disenrollment from the University if this information is found to be inaccurate or false. Please provide the following information and include your signature: Name _______________________________________________________________________________ Last

First

Phone Number ______________________________ Cal Poly Empl ID ________________________

Middle Initial

Major __________________________________

Cal Poly Email Address __________________________

Signature ____________________________________ Date ___________________________________ Fax the completed contract to the University Writing & Rhetoric Center at (805) 756-7497 or Scan and email the completed contract to [email protected].

A confirmation email will be sent to your Cal Poly email address upon receipt of this contract.