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S-III -- Student/Parent Response Form
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This Form must be completed by each USAMO student and his or her parent/guardian and returned by FAX 303/374-6339 (Emergency FAX 402/472-6087) or mailed to the AMC Office so that it is received on or before April 13.
Complete all items carefully.
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Section A- USAMO Participant High School Certification
I certify that my last month as a regular high school student, either due to graduation or to early enrollment in a college degree program, will be no sooner than _______________ (Month and year).
Students who are not citizens of the USA are eligible to participate in the USAMO if they are legal residents in the U.S.A. or Canada.
CITIZENSHIP Status: USA Citizen_____ *Legal Resident of USA______ or Canada_____
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| Date of Birth: ____________________ |
Place of Birth______________________ |
Signed: ______________________________________
USAMO Participant |
Date:_____________________ |
Verified by:___________________________________
Parent/Guardian |
Date:_____________________ |
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Section B - USAMO/IMO PARTICIPATING STUDENT
(American Citizen or Legal Resident)
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I have read the “Instructions to Participate-Form S-II” and my teacher has made arrangements for me to take the USAMO on Tuesday, April 19, 2005 and Wednesday April 20, 2005.
#3
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#1
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#1 Circle one: If invited, I (am or am not) willing to attend the 2005 Mathematical Olympiad Summer Program (June 13-July 3) |
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#2
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Circle one: I ( am or am not ) able to present proof of United States citizenship or Permanent Residency. |
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#3
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Circle one: If invited, I (am or am not) willing to serve as a USA Team Member at the IMO, July 8-19, 2005 in Merida, Mexico. |
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| Signature:_____________________________ |
Date:_____________________ |
| Home phone(_____)____________________ |
Email:___________________________ |
Full Name (please print, including initial):
____________________________________________________________________ |
| May/June Mailing Address: _______________________________________________ |
| _________________________________________________Zip: ________________ |
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S-III
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