English as a Second Language Placement Examination (ESLPE)

Registration Form

Please fill out this form as accurately as possible.

UCLA I.D. Number, if you have one:

Family (or Last) Name:      First Name:       Middle Name:
Birth Date (Month/Day/Year): / / -- mm/dd/yyyy
If you have previously registered and would like to cancel, provide only your full name and birthdate and check the following box:

Gender:  Male  Female  

E-mail Address:  (Please enter a valid e-mail address in order to receive important exam information after completing this form.)

Country of birth:

Native Language: 

Have you taken the UCLA ESLPE before?  Yes  No  

If yes, when did you take it?  Quarter: Year: 

Status: Undergrad (Freshman)  Undergrad (Transfer)  Visiting Scholar/Other
             Graduate  Education Abroad 

Undergraduates Only

 

When did/will you enter UCLA?

Quarter: Year? 

Major field of study:

Graduates & Visiting Scholars

 

When did/will you enter UCLA?

Quarter: Year? 

Major field of study:

Please select the exam session you will be attending.
Remember, you will have to check-in in person at Rolfe 1200 half an hour before the exam begins.

The registration for the next term will open the day after the last exam date of the current registration term. (For example, registration for the exams in Fall will be open the day after the last exam in summer).