REGISTRATION FOR IB EXAMS MAY SESSION 2016
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.
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.
______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