AP Examination Registration May 2011

Please PRINT legibly, using BLOCK CAPITALS.

Your timetable – Subject (Room)

Block 1-1: _______________ ( ) 2-1: _______________ ( )

1-2: _______________ ( ) 2-2: _______________ ( )

1-3: _______________ ( ) 2-3: _______________ ( )

1-4: _______________ ( ) 2-4: _______________ ( )

First Name: _______________________ Last Name: __________________________________

Student number: ____________ HR: ______ Mathematics teacher: __________________

Course taken at Churchill: ____________________ in which the teacher feels that

the candidate has demonstrated that he/she is well prepared to write the following

AP Calculus course (circle one): AB or BC on Wed, May 4 at 08:00

Teacher signature: ___________________________

Note:
Students not physically enrolled in a preparatory course at Churchill School cannot be accommodated.

Please return this form along with a cheque in the amount of CAD60, payable to Sir
Winston Churchill Secondary School. This fee represents the VSB subsidized cost,
available ONLY to VSB students, per AP examination.

The surcharge to register for an alternate (LATE) examination due to a conflict is

CAD50 per examination. There is no VSB subsidy that applies to this AP surcharge.
If a late sitting is necessary, indicate the conflict: ____________________________

I understand that this registration fee is non-refundable.

Student signature: ________________________________

Date: ______________________