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At-Home Internet Testing
Verification Form

Please, only the parent or guardian who has completed a permission form should fill in the information below.

I supervised ___________________________________ (Please print) taking the following chemistry exam at home over the Internet, and that no outside material, such as notes or texts, were used.  (A calculator and a periodic table, however, may be used.)

TEST: __________________________________________________
                                    (please print)

SCORE: _________________________

TIME: _________________________

ID: _________________________

CODE: _________________________

Your name ___________________________________
                                (please print)

Signature ___________________________________ 

Date _______________