Candidate



2016 AICE Exam RegistrationPlease complete this registration form and return it to Ms. Cooperman immediately.Name ________________________________________ _________________________________________ ___________Please Print Last Name First Name Middle InitialDistrict Student Number _______________________________ Your mobile number ______________________________Date of Birth ________ ______________ _________ Grade Level __________ _______Male _______Female Day Month Year (Check one.)_______ Check if you currently have a 504 Plan or an IEP that allows for extended time or other exam modifications._______ Check if English is NOT your first language.Circle the year that you took your first AICE exam: 2014 June 2015 November 2015 2016Place an “X” next to the exams you plan to take in the spring of 2016. If you are not going to sit for the exam, please mark it with “O.” You will not be penalized if you opt out of exam prior to 2/12/16. (In order to qualify for the AICE Diploma, you must attempt the six required exams for a diploma by 2016 and seven exams by 2017.)*_____ AS Art and Design (April 22, 25)_____ AS Business Studies (5/12, 16 PM)_____ AS English Language (5/4, 12 AM)_____ AS Environmental Management (5/24, 26 PM)_____ AS General Paper (5/3 AM)_____ AS Geography (5/13 AM)_____ AS Global Perspectives (5/12 PM)_____ AS History (5/5, 11 PM)_____ A Level History (5/20, 6/8 PM)_____ AS Literature in English (5/11, 27 AM)_____ A Level Literature in English (6/6, 9 AM)_____ AS Marine Science (4/26, 27 PM)_____ A Level Marine Science (4/28, 29 PM)_____ AS Media Studies (5/19 PM)_____ AS Psychology (5/10, 17 AM)_____ AS Sociology (5/16, 31 PM)_____ AS Spanish Language (5/9, 11 PM)_____ AS Thinking Skills (5/5, 10 PM)_____ A Level Thinking Skills (5/16, 18 PM)_____ Travel and Tourism (6/7 PM)_____ Other _________________________Based on the dates listed above, do you have any conflicting exams? ______ Yes ______ No Please list them: ____________________________________________________________________________________________________________________________________________________________________________________________________________If you are currently enrolled in the AICE course, the exam is free. If you register for an exam in a subject in which you are not enrolled or have taken previously, you will need to pay for that exam. AS Level exams are $89.90 and A Level exams are $137.58. Money is due to Ms. Cooperman by February 12; checks must be made payable to Wellington High School.Are you applying for the AICE Diploma in June 2016? ______ Yes ______ No (You must have successfully completed three AICE exams in order to apply for the diploma.)(If you applied last year and failed to earn the diploma, you must pay the application fee of $103.19 by 2/12/16.)If you answered “yes” above, please list all of the AICE exams that you have taken and the grade you earned in each.AICE ExamASAGrade Earned12345678Do you hope to qualify for the Bright Futures Scholarship through the AICE Diploma? ______ Yes ______ NoIf you are missing an exam in June due to a conflict, list the exam(s) that you plan to make-up in October/November of 2016. (Please keep in mind that graduating seniors may not take AICE exams in the fall.)____________________________________________________________________________________________________________________________________________________________________________________________________________Finally, please plan to leave your electronic devices in a safe place on test days. Do NOT bring them to the test site as you may not be able to retrieve them until the end of the day. Also, be sure to leave book bags in a safe place as you may not bring them into the test room.If you miss a scheduled exam because of a medical emergency or a death in the family, please provide the documentation to Ms. Cooperman immediately so that she can apply for an exam exemption. (Only doctor’s notes are acceptable for medical emergencies.)If you have any questions, please see Ms. Cooperman in room 2-110, email her at susan.cooperman@, or call 561-753-9412._________________________________________________________Date __________________________Your Signature ................
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