2003 INDIANA STATE MATHEMATICS CONTEST REGISTRATION FORM

The students listed below will take the indicated test. (Check one)

Pre-Algebra Algebra II/Integrated Math III ___

Algebra I/Integrated Math I Comprehensive ___

Geometry/Integrated Math II ___

Name of Student (Please print or type)

1. ____________________________________

2. ___________________________________

3. ____________________________________

4. ____________________________________

5. ____________________________________

6. ____________________________________

7. ___________________________________

8. ___________________________________

9. ____________________________________

10. ___________________________________

11. ___________________________________

12. __________________________________

13. ___________________________________

14. __________________________________

15. ___________________________________

16. __________________________________

17. __________________________________

18. __________________________________

19. ___________________________________

20. __________________________________

Name of Faculty Sponsor ________________________________________________

Name and Address of School ____________________________________________

____________________________________________

____________________________________________

I certify that each of the students listed above is enrolled in the indicated course during the 2002-2003 school year.

_______________________________

(Signature of School Official)

_____________________________________

(Title)

The site coordinator at the test site where you plan to take the test must receive

this form, a copy, or a facsimile by April 2, 2003.