2004 USAMO Teachers Manual -T-II -- 2004 USAMO Acknowledgement Response Form

VIII. USAMO Teacher & Student Forms
T-II -- 2004 USAMO Acknowledgement Response Form

To be completed by the USAMO Exam Manager

This form must be completed by the USAMO exam manager and returned to the AMC Office either by FAX 303/374-6339 (Emergency FAX 402/472-6087) or mail. Confirmation (either by fax or postal mail) must be received on or before April 21, 2004.

This is to inform you that I have received official notification of the qualified student(s) and will strictly follow the implementation instructions.

Signature: ____________________________________________________________

Date: ________________________________________________________________

Name (print): __________________________________________________________

Email: _______________________________________________________________

Name of School: _______________________________________________________

CEEB: ___ ___ ___ ___ ___ ___

School Address: ______________________________________________________

_____________________________________________________Zip: ____________

School Phone: (_______) _______________

School Fax: (if available): (_______) _______________

Please print the name(s) of your student(s) participating in the 2004 USAMO below:

______________________________ ______________________________

____________________________________________________________

The following student(s) will be using a non-technical translation dictionary during the examination: