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2017_Registration_Form
This is the 2017 Registration form for the Virginia Local Section Exam
Date of Registration
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High School
Your answer
County
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Approximate 9th - 12th grade enrollment
Type of School
Contact Teacher's Name
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Contact Teacher's Email
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Contact Teacher's School Phone Number
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Contact Teacher's Cell or Home Number
(only to be used if a student is nominated for the National Examination)
Your answer
Additional Teachers who will be participating in the Olympiad examination with email contact
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Examination Date: Between February 27 and March 24
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Number of student who will take the First Year Examination
(NOTE: A teacher may nominate any student in their class or the school who they feel is prepared to take this exam, the student does not have to be taking a chemistry course to be nominated.) :
Your answer
Number of students who will take the Second Year Examination
(NOTE: A teacher may nominate any student in their class or the school who they feel is prepared to take this exam) The teacher will email a list of the nominated students, their teacher and which test they are attempting. Additional information for the Second year examination is contact information (phone and email) for each student. This information will only be used if the student is nominated to take the National Exam in April :
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TEST ADMINISTRATOR'S NAME:
All testing for the local examination will be conducted at the high school under the following rules. 1. Neither the students’ chemistry teacher nor anyone directly involved in the instruction of chemistry to the students taking the examination should be involved in the administration of this examination. 2. The Test Administrator in each school, preferably a guidance counselor, should proctor the examination, be responsible for its security, and returning the completed answer sheets to the chemistry Olympiad chair. 3. The test must be administrated on a single day between the given dates. 4. A single copy of the exam will be mailed along with enough answer sheets and the test direction to the Test Administrator at least 48 hours in advance of the school’s selected date for giving the examination. It is asked that the test administrator make enough copies of the examination to be given to each student registered in the competition.
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Test Administrator's Work or Cell
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Test Administrator's Email
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