_OLD VERSION_MAT Placement Intake Form

This form has moved

In order to expedite placement, we developed the Math Placement Form to help you determine the appropriate levels of math course work that align with your personal educational goals, skills, and abilities. Please answer all questions to the best of your ability.

Please visit https://CCAurora.formstack.com/forms/mathplacement to begin the placement process.

Short Answer*

Math Placement Intake Form

The Math Placement Intake form was created to help you determine the appropriate levels of course work that align with your personal educational goals, skills and abilities.

Your responses will help determine your course placement and the classes you can take.

Please answer the following questions to the best of your ability. Students are only allowed to complete this form once. Duplicate submissions will not be processed.

Name*

First Name

Last Name

CCA Student Number*

Phone Number*

Email*

What program are you interested in pursuing at CCA?*

Please check all that apply:*

I am a student who plans on using VA benefits. I am participating in the Concurrent Enrollment program at my High School. I want to apply to the Colorado Film School. I want to apply to the Diesel Power Mechanics program. I have an F1 Visa or I am in the process of obtaining an F1 Visa. None of the above.

High School Information

Did you graduate High School within the United States?*

Yes No

Select the year of your High School graduation.

2021 2020 2019 2018 2017 and before

What was your cumulative High School GPA?

4.00 - 3.60 3.59 - 3.10 3.09 - 2.75 2.74 - 2.60 2.59 - 2.10 2.09 and lower

Did you complete a High School math class within the past 3 years?

Yes No

What was the highest/last math class you took in High School?

Algebra I Algebra II Geometry Trigonometry Pre-Calculus Calculus AP or IB Math

Did you earn a B or higher in that math class?

Yes No

Indicate the final grades that you earned in the following High School math courses:

Indicate the final grades that you earned in the following High School math courses:
	A	B	C	D/F	I did not take this course
Algebra I or equivalent course	Indicate the final grades that you earned in the following High School math courses:: Algebra I or equivalent course (A)	Algebra I or equivalent course (B)	Algebra I or equivalent course (C)	Algebra I or equivalent course (D/F)	Algebra I or equivalent course (I did not take this course)
Algebra II or equivalent course	Algebra II or equivalent course (A)	Algebra II or equivalent course (B)	Algebra II or equivalent course (C)	Algebra II or equivalent course (D/F)	Algebra II or equivalent course (I did not take this course)
Geometry or equivalent course	Geometry or equivalent course (A)	Geometry or equivalent course (B)	Geometry or equivalent course (C)	Geometry or equivalent course (D/F)	Geometry or equivalent course (I did not take this course)
Trigonometry	Trigonometry (A)	Trigonometry (B)	Trigonometry (C)	Trigonometry (D/F)	Trigonometry (I did not take this course)
Pre-Calculus	Pre-Calculus (A)	Pre-Calculus (B)	Pre-Calculus (C)	Pre-Calculus (D/F)	Pre-Calculus (I did not take this course)
Calculus	Calculus (A)	Calculus (B)	Calculus (C)	Calculus (D/F)	Calculus (I did not take this course)
AP or IB Math	AP or IB Math (A)	AP or IB Math (B)	AP or IB Math (C)	AP or IB Math (D/F)	AP or IB Math (I did not take this course)

Prior Test Score(s)

Please complete the following fields that apply to you. Scores are considered valid if they are within 5 years from test date. If your scores are used for placement, you will be required to provide an unofficial copy to CCA.

SAT Math

ACT Math

GED Math

Accuplacer Math

Prior College or University Information

Did you complete a college/university Math course within the United States?

Yes, and I earned a C or higher in that course. Yes, but I did not earn a C or higher in that course. No

Enter the name of the course

Example: Math for Liberal Arts, College Algebra, Business Math

Enter the name of the college/university

Enter the year you completed this course

Self-Assessment Questions

In the following section, you will be presented with a number of self-assessment questions about your math skills. Please explain your math skills in 1-3 sentences.

How do you usually feel while working on math problems?*

Would you say you are good at math concepts or do you struggle with math concepts?*

How would you describe yourself as a student with respect to math classes?*

How do you usually feel about Math?

Have you taken any Math courses in the past 3 years? If so, which ones?

Would you say you are good at Math? Struggle?

Anything you want me to know about your Math abilities?

Waiver of Liability

In lieu of ACCUPLACER placement test , I release the State of Colorado, The State Board for Community Colleges and Occupational Education, Community College of Aurora and its employee for my decision to use the method for multiple measures placement. Should I fail to complete the courses with a “C” or above, I take full responsibility for this decision. I understand that I take full responsibility for my decision and cannot hold any of the above entities or individuals accountable for my actions.

Name*

First Name

Last Name

I agree to the Waiver of Liability Statement Above*

Yes No, I want to take the Accuplacer test. I understand that I will be subject to the non-refundable testing fee.

Selecting "Yes" will count as a signature for the Name above

Todays' Date*