Foreign Language Placement Questionnaire

First Name:
Last Name:
Address line1:
Address line2:
Social Security:
(last four digits only)
Cell Number:
Email Confirm:
Have you ever attended any college or university since high school?
             If yes, where?
Are you a veteran or currently in the military?
Please provide accurate and truthful information to the questions below. Failure to do so may affect your class program and financial aid status, and delay your graduation date. All the information contained in this application will be treated confidentially and will be used for institutional purposes only.
Major - Program of Study
If you are not sure of what your major/curriculum is, please ask an instructor or a test proctor
Foreign Language Background
1. Indicate which of the following languages you studied and passed in high school or other colleges: 
2. Indicate how many years you studied that language in high school:  
3. Indicate how long it has been since you studied that language:  
4. I have a:  
Foreign Language Choice
5. Indicate which foreign language you would study if you had to fulfill a foreign language requirement or a Liberal Arts and Sciences/Humanities elective requirement:  
6. My relatives speak the language I have chosen to study at QCC:  
I hereby certify that all the information in this application is accurate and complete.