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English Proficiency

This document is a proof of English proficiency form for a student applying to Southwestern Community College. It requests information such as the student's name, address, date of birth, citizenship, English proficiency test scores, and signature to certify the accuracy of the information provided.

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30 views1 page

English Proficiency

This document is a proof of English proficiency form for a student applying to Southwestern Community College. It requests information such as the student's name, address, date of birth, citizenship, English proficiency test scores, and signature to certify the accuracy of the information provided.

Uploaded by

my422xc8ft
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PROOF OF ENGLISH PROFICIENCY

Please complete this information which is necessary for acceptance to Southwestern Community
College. Make sure all blanks are completed (please print all information).

1. __________________________________________________________________
Family Name First Name Middle

2. Preferred enrollment date_________________________________________________


Semester Year

3. Male__________ Date of Birth______/______/________


Female________

4. Country of Birth________________________________________________________

5. Country of Citizenship___________________________________________________

6. Student’s current mailing address:

Street City State/Province

Country Postal Code Telephone Number

7. Permanent home address:

Street City State/Province

Country Postal Code Telephone Number

8. English is my first/native language - Yes No

If no, please provide required English proficiency test you plan to take or have already taken:

Placement Score (Please circle which test – TOEFL, IELTS, DUOLINGO,


ACCUPLACER): ___________
Place of testing________________________
Date of testing_________________________

Official transcript from previous college experience in the United States from an accredited
college/university proving completion of composition I (ENG 105) with a “C” grade or better.

Official test results or English proficiency must be sent to the SWCC admissions office prior to
acceptance.

I certify that the above statements are true and correct to the best of my knowledge.

STUDENT’S SIGNATURE DATE


It is the policy of Southwestern Community College not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual
orientation, gender identity, creed, religion, and actual or potential family, parental or marital status. If you have questions or complaints related to compliance with this policy, please contact:
Equity/Title IX Coordinator, Southwestern Community College (Administration Center), 1501 W. Townline St., Creston, IA 50801; phone, 641.782.1456; or email,
[email protected], or the Director of the Office for Civil Rights, U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor,
Chicago, IL 60604-7204; phone, 312.730.1560; fax, 312.730.1576; TDD, 800.877.8339; or email, [email protected].

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