Speech - COMM 105
Proficiency Test Application
Name: ________________________________________________________________________
Social Security Number: _________________________________________________________
Address: ______________________________________________________________________
Telephone: ____________________________________________________________________
Technology: ___________________________________________________________________
High School(s) Attended: ________________________________________________________
High School, College, Employment-Related, or Life Experience in Speech Presentation Skills:
Name of Course(s) Year(s) Grade(s) Textbook(s) Teacher(s)
_______________ ________ ______ ____________ ________
_______________ ________ __________ ____________ ________
_______________ ________ __________ ____________ ________
_______________ ________ __________ ____________ ________
Experience:
Social Organizations: _______________________________________________
Debate Tournament Participation: _____________________________________
Forensic Club:_____________________________________________________
Individual Contests: ________________________________________________
Other Relevant Experience:
Describe any other activities which include substantial speech experiences, such as theater experience, radio and television experience, organizational offices, Toastmasters, etc.
Student�s Signature Date
_________________________ _____________