2016 AP Exam Registration
Registration Forms Due: ___________

STUDENT INFORMATION

Student Name:  	_________________________________	_________________________________	____
Full Legal Name	 Last					 First					 M.I.

Grade: ______	    Homeroom: _____________________	Phone Number: _________________________

FEES
Check One: 
___   Regular Exam: $92 per exam 
___   Fee-Reduced* Exam: $_____ per exam 
	* Student has qualified based on the eligibility criteria.

Total # of Exams Ordered: _________ Total Amount Due: ________Total Deposit: ________

Minimum Deposit Due By _________:  $_________   ($ ___ per exam)
Check amount: _________ Check number_________  OR cash amount: _________ 
Received by: ____________________________________________________ 

Final Balance Due By _________: $_________   
Check amount: _________ Check number_________  OR cash amount: _________ 
Received by: ____________________________________________________ 

Please make checks payable to: ________________________________________________
A copy of this form will serve as your receipt.

REFUND POLICY
•	If a student registers for an exam and cancels before _________, a refund of $_____will be issued.  
•	If a student registers for an exam and cancels after _________, a refund of $_____will be issued.  
•	Once a student begins an exam, no portion of the fee is refundable.

PREADMINISTRATION SESSION
All students must participate in a preadministration session to complete exam-related paperwork. 
Please place a check next to the preadministration session you will attend: 
___   Preadministration Session 1: <Date, time, and location>
___   Preadministration Session 2: <Date, time, and location>

ACCOMMODATIONS
If you have requested and been approved by the College Board for testing accommodations, please provide your SSD Code: _______________________ 

List each exam name:                                  		List specific accommodations requested and approved:
________________________________		____________________________________________________
________________________________		____________________________________________________
________________________________		____________________________________________________

SIGNATURES
Student Signature: _______________________  Parent/Guardian Signature: _________________________