Direct Enrollment for Adults Name First Last ID# Program of Study Advisor High School Graduation Year GED Yes No State Date Received MM slash DD slash YYYY I am choosing the following alternative to VPT Placement Test Informed Self - Placement ( Student Group = SF21) Active Military and Veterans Students (Student Group = VF21) Career Studies Certificate (Student Group = CF21) Career Studies Certificate Previously completed: CSC Awarded by (Ex: MECC): CSC Graduation Date MM slash DD slash YYYY I will begin at the following level of English: EDE 10 EDE 11/ ENG 111 ENG 111 I will begin at the following level of Mathematics: MDE 10 MDE 60 MTH 111 MTH 132 MTH 133 MTH 154 / MDE 54 MTH 154 MTH 155 / MDE 55 MTH 155 MTH 161 / MDE 61 MTH 161 * Required I certify that I have met with my Advisor and I fully understand the benefits and the potential challenges of self-placement. Signature of StudentDate MM slash DD slash YYYY Signature of AdvisorDate MM slash DD slash YYYY Office use ONLYES Staff Student Group Date MM slash DD slash YYYY
