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INTERNATIONAL BACCALAUREATE TESTING FEES
STUDENT’S APPLICATION FORM
Students who enroll in an IB course must take the course’s IB examination. Registration fees for IB tests will be paid for by Hanover
County; however, the subject fees are the responsibility of the parent. The subject fee this year is $110.00 per exam. Note that
submitting information late could result in significant late fees, which could total well over $100, pursuant to the policy of the IBO.
Hanover County is not responsible for late fees unless the tardy registration is the fault of the school.
Student Name
(PRINT your name as it should appear on your IB certificate or diploma.)
Ethnicity (Circle one)
(these are IB identified categories)
American Indian/Alaska Native
Hispanic
Asian/Pacific Islander
Other
Black/Non-Hispanic
White/Non-Hispanic
Student ID No.: _________________________
Date of Birth
Age ________________________
Name of High School Atlee High School
Grade Level: 11 or 12 (circle one)
Is English your first language? (Circle one)
Yes
No
Gender:
Male or Female (circle one)
List any IB examinations that you took last May.
What is your IB student status this school year? (Circle one.)
Anticipated
Diploma
Certificate
Senior IB Diploma Candidates: What is your Extended Essay Subject?: _______________________
IB Course Enrollment:
____ English HL B (Mrs. Edelman)
____Chemistry SL (Mr. Pavelis)
____ Spanish SL B (Mrs. Lindemann)
____Computer Science SL (Mrs. Malick)
____ German SL B (Mrs. Hughes)
____ Math SL (Mr. Shadik)
____ French SL B (Mr. Hayes)
____Math HL B (Mr. Shadik)
____ Latin SL B (Mr.Maslanka)
____Math Studies SL (Mr. Rogers)
____ Economics SL (Mr. Noel)
____ Film Studies SL (Mrs. Layne)
____ History of the Americas HL B (Mrs. Leise)
____ Visual Arts HL B (Mrs. Fisher)
____ Psychology SL (Ms. Sigel)
____ Spanish ab inito (Mrs. Dulaney)
____ Biology HL B (Mrs. Trickett)
Your total
for 1 class
for 2 classes
for 3 classes
for 4 classes
for 5 classes
for 6 classes
for 7 classes
$110.00
$220.00
$330.00
$440.00
$550.00
$660.00
$770.00
Please double check the courses for which you are enrolled and calculate the fees for the May 2015 exam session. Return
this form with a check made payable to AHS to Mrs. Edelman in the IB Office 817A by 11/3/14. Please indicate “IB Exam
Fees” in the memo field. The student and parent who sign below agree to the terms of this document. The student and parent
also certify that he or she has read and understands the IB Diploma Program General Regulations. A link for the regulations can
be found on the school’s web site. If you would like a paper copy of the regulations or have questions, please contact the school’s
IB Coordinator at wedelman@hcps.us.
Student’s Signature
Parent’s Signature
Date
Date