IB Exam Registration for SENIOR DIPLOMA - May 2015
Part 1: IB Exam Registration
Name __________________________________
Graduation Year: 2015
Please circle the exams you will be taking in May of 2015:
Group 1 - Language A1
English
HL
Group 2 - Language B
Spanish
SL
Extended Essay Subject:
French
SL
___________________________________
Group 3 - Individuals and Society
History
SL
History
HL
Psychology
SL
Psychology
HL
Economics
SL
Exam(s) Taken Last Year:
Group 4 - Experimental Sciences
____________________________
Biology
SL
Biology
HL
Chemistry
SL
Chemistry
HL
Physics
SL
Physics
HL
Mathematics
HL
____________________________
Group 5 - Mathematics
Math Studies
SL
Mathematics
SL
Group 6 - Arts and Electives
IB Music
SL
IB Visual Arts
SL
Circle one:
solo
group
composition
IB Visual Arts HL
Optional - Extra Certificate – this does not count toward your IB Diploma score.
Circle all exams you are taking above, and indicate below which exam is extra
(not applied toward diploma): ________________________________
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Registration Information- IB Exam Fees- May 2015 Exam
Session
PART 2: IB Diploma Program Exam Fee Calculation
Registration Fee (only paid one time)
Taking all IB exams senior year
$160
One or two IB exams taken Junior Year $0
(Registration fee is only paid once during the 2 years)
Subject fees
$110 per subject
Number of exams circled above _______ x $110
Postage Fee
Due to increased costs of international courier
_______________
______$10____
TOTAL
Your check should be written to Niwot High School. Payment by credit card
is available through RevTrak (see pg.5 for more information).
Please check this box if you need to set up a payment plan…………………
 Please check this box if you receive any examination accommodations.
Please explain:
__________________________________________________________________________________________
__________________________________________________________________________________________
IB Exam registration with payment is due
no later than
October 20, 2014 to the NHS’s IB Office
Changes to Exam Registration after October 20th incur a fee from IBO.
Please check exam registration details carefully. After January 15th exam
registration changes can only occur in exceptional circumstances (this
incurs an even higher fee).
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PART 3: Personal Data
Please PRINT all information clearly as this is how your name will appear on
all IB correspondence, diploma, exams, etc. Use the same name you will use
on college applications.
Name (as you want it to appear on the IB diploma)
First Name
M.I.
Last Name
(Below information for IB informational purposes only):
Date of Birth
Day
Gender
Month
_________ Male
Ethnicity
Year
_____________ Female
American Indian/Alaska Native
Asian/Pacific Islander
Hispanic
White/Non-Hispanic
Black/Non-Hispanic
Other
First Language: _________________________________
Second Language (if fluent): __________________________________
First Nationality (country on your passport):
__________________________________________________________________
There is an additional charge to change registration
details once registration has been submitted to IBO.
Please check all details carefully!
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Part 4: Payment and acknowledgement
Cash Amt. : ______________
Check Amt. : ______________ Check # _____
IB Grocery Certificate Account Amt. _____________________
(Please make sure to check with Ms. Hauck for an accurate amount to be included)
---------------------IF YOUR CHILD IS ON FREE/REDUCED LUNCH,
WE CAN PROVIDE PAYMENT ASSISTANCE THROUGH THE STATE.
THE AMOUNT OF ASSISTANCE IS NOT DETERMINED UNTIL A LATER
DATE. YOU WILL BE REQUIRED TO MAKE SOME PAYMENTS. YOU MUST
PROVIDE A COPY OF YOUR FOOD SERVICES LETTER TO INDICATE PROOF OF
NEED. PLEASE ATTACH THE LETTER TO THIS REGISTRATION FORM (OR
BRING IT IN FOR US TO COPY).
-------------------We reviewed all information and registration details provided in this packet
and understand that it is our responsibility to cover all IB exams related costs
even in the case of withdraws from the IB DP and particularly when the
decision to withdraw from the program is made post IB exam registration
deadlines. We understand that NHS advances IB exam payments to comply
with IBO‘s payment due dates and collects agreed upon payments from
parents over the course of the school year in many instances accommodating
parents/guardians with payment plans. Consequently, we acknowledge that in
order for an IB student to take his/her IB exam/s the associated costs must
have been paid for no later than by May 1 and before the exam/s
administration date.
Candidate Signature
Date
Parent/Guardian Signature
Date
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IF YOU ARE PAYING BY CREDIT CARD:
The RevTrak is our provider of online payment solutions in the St. Vrain Valley
Schools. For easy access to RevTrak, please visit Niwot High School’s main webpage
and look on the right hand side for the RevTrak’s icon like the one on the top of this
page. To calculate your student’s exam payment, you may want to refer to the below
listed options. The RevTrak list should mirror the list below. RevTrak access
instructions are attached to this registration form.
Payment Options for RevTrak
1 Exam + Registration
2 Exams + Registration
3 Exams + Registration
4 Exams + Registration
5 Exams + Registration
6 Exams + Registration
1 Exam only
2 Exams only
3 Exams only
4 Exams only
5 Exams only
6 Exams only
$270 + $10= $280
$380 + $10= $390
$490 + $10= $500
$600 +$10= $610
$710 +$10= $720
$820 +$10= $830
$110 +$10= $120
$220 +$10= $230
$330 +$10= $340
$440 +$10= $450
$550 +$10= $560
$660 +$10= $670
⃰ Please note that all listed above prices are based on an on-time registration. Late
registrations will a subject to increased exam fees as per IBO’s IB exam fee schedule.
One-time IB exam
Additional exam fee
Deadline
registration fee
(per each IB exam)
On-time (by 10/20/14)
$160
$110
11/15/14-1/15/15
$214
$35
After 1/15/15
$459
$140
⃰ If you experience any problems accessing RevTrak for exam payments, please
contact Debbie Hauck at: hauck_debra@svvsd.org.
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