Declaration of Interest in the Pre International Baccalaureate Diploma Programme

(Rising 9th Grade)

Student Name_____________________________________________ Graduation Year__________
Possible interest:
Certificate

Full IB Diploma

Individual IB Subjects only

IB Career

Student cell # _________________ E-mail address______________________________________

Home phone # ________________

Gender:

M F

Date of Birth: ____/____/____

month

Race (for data purposes):

White
American

Black Asian/Pacific Islander

Hispanic 2 or more

day

year

Native

I understand that I will need to register for the most challenging courses in the sequences supplied to me in
order to ready myself for IB work in the junior and senior years and succeed in these courses. At the 9th Grade
level these include:
English I Honors
World History Honors
Biology Honors
Either Math II and/or Math I
Spanish I and/or Spanish II
Health/PE
And optionally:
Career & Technical Education
Fine Arts (Performing or Visual) Intermediate

Parent/Guardian Information (Please Print):

Mothers name: ___________________________________________ Phone: _________________
Fathers name: ___________________________________________ Phone: _________________
Address: ________________________________________________________________________
________________________________________________________________________
Fathers work phone #: ___________________ E-mail address: _____________________________
Fathers cell phone #: ____________________ Mothers cell phone #: ________________________
Mothers work phone #: ___________________ Email address: _____________________________