IB Exam Registration Form for Testing in May, 2003

IB Exam Registration Form for Testing in May, 2003


Brooklyn Center International Baccalaureate Programme

Last name ______First ______Middle ______

(Must be same as last year and the way you want it to appear on Certificate/Diploma) (Initial or full middle)

Select one of these choices:

____ I am a Course Candidate (junior or senior). I plan to take exams without going for the IB Diploma.

____ I am an Anticipated Diploma Candidate (currently a junior).I may take one or two standard level exams.

____ I am a Diploma Candidate (currently a senior). I will take at least three higher level exams and a total

of at least six exams in two years.

Address: ______

City: ______State ______Zip Code______

Home phone: ______Home email: ______

Birthday ______Gender _____ Social Security. #: - ______

(Month) (Day) (Year) (Last 4 digits)

Grade _____ Year you are graduating: ______Race/Ethnicity ______

Country of Birth ______What is your citizenship? ______

Language spoken at home ______Additional languages ______

Please check the following if you are eligible for Free and Reduced Lunch* ______

*There are no test fees for students eligible for Free and Reduced Lunch. You must attach a copy of your Lunch Letter

I took one or two exams last year as a junior. ______Yes ______No


Please select the exams you will take this spring, May 2015:

EE Subject Area (Diploma Candidates Only) ______

_____ English A1 HL

_____ English A1 SL

_____ Spanish HL ** _____ French HL **

_____ Spanish SL ** _____ French SL **

_____ History of the Americas HL

_____ History of the Americas SL

_____ Environmental Systems and Societies

_____ Mathematics SL

_____ Math Studies SL

_____ Visual Arts HL

_____ Dance SL

_____ Dance HL

**Indicates “with teacher permission only.” If you are unsure of any choices, and wish to discuss it with the IB Coordinator, please come to the IB Office.

Please read and initial each of the statements below, to acknowledge that you have received the information.

Student Parent

______If a student fails to take or complete in good faith any part of an IB exam

for which they are registered, they will be assessed a $95 missed-test fee.

______All IB scores include classroom components (internal assessments) aside from

the written May exam. A student who misses any component of the IB

requirements will not be allowed to take the written exam and will be subject to

the missed-test fee of $95.

______In order to take an IB exam the student must have taken and completed the

corresponding IB course. We assume that students who register for an exam are

taking the corresponding course.

______Students who register for an IB exam and subsequently drop the IB course will

be subject to the $95 missed test fee since it is not possible to have money

refunded from the IB Organization after registration is complete.

Parent signature ______Date ______

Student signature ______Date ______

Forms and documentation are due (without penalty) on or before Monday, November 3, 2014

______If you need special accommodation for an exam, please attach a written explanation of the accommodation and documentation. This must be done if extra time is needed.

______This must also be done if there is a medical condition that may need to be noted during an exam testing session. Attach a written explanation of the medical situation and documentation.

Please complete this form and return it to Mrs. Peña in the IB Office as soon as possible with your payment. ISD 286 IB exam fees are non-refundable.

All registration forms and payments are due on or before Monday, November 1, 2015 at 3:00 PM

Make checks payable to: Brooklyn Center High School


Cost is $30.00 for the first exam and $25.00 for each additional exam. All fees are non-refundable.

Late fees: Exam registration after Monday, November 1, 2015 is $70.00 per exam.

From November 15 until December 1, the cost is $125.00 per exam.

$30.00 (1st exam) plus $25.00 x _____ (# of additional exams) = $ ______(total amount due)

All students taking an IB examination will receive an IB tassel to wear in addition to their BCHS tassel at graduation.

IB OFFICE ONLY: Total exam fee paid $ ______Date: ______

Cash ____ Check ______

Return to: Terry Peña (612-226-0103)

IB Diploma Programme Coordinator

Brooklyn Center High School

This form and your registration fee are due back at the IB Office on or before

Monday, November 1, 2015 at 3:00 PM