The Contest Manager and the Principal, Vice Principal, or Headmaster must sign this form which is to be returned with your student Answer Forms.

1. I certify that the exam package(s) were retained in their sealed condition within an hour of the start of the contest.
2. I accept for our school the rules and procedures described on this page and pages 5-7, and accept that failure to follow these rules and procedures may result in DISQUALIFICATION from official standing of all scores from our school.

I certify that the following statements are true or that, if there are any exceptions, I have checked the box at the bottom of this page and have listed them on the back of this page. I understand that the absence of either signature from this form, and a consideration of the exceptions may result in DISQUALIFICATION of all scores from our school.

1. The contest was held on Tuesday, February 1, 2005.
2. The AMC 10-A/AMC 12-A were given at the same time.
3. The participants were continually monitored during the contest, and they were separated by an empty space, if possible.
4. No aids were permitted other than scratch paper, graph paper, ruler, compass, protractor and calculator (see Section IV. Item 4).
5. Participants had exactly 75 minutes working time.
6. No students were permitted to proctor or grade the contest.
7. The instructions relating to the opening of the "Complimentary Solutions Envelope" and/or Solution Packets were followed.
8. After the contest, the answer forms were kept secure and no changes were made in the answers.
9. No Home School parent assisted in the administration of the contest.
10. I have followed all the rules as stated in this Teachers' Manual.

PLEASE INDICATE THE EXACT NUMBER
OF AMC 10-A/AMC 12-A ANSWER FORMS RETURNED FOR GRADING.____________