Human Anatomy and Physiology: Medical Laboratory Science Department

ao Doctors College
Medical Laboratory Science

Department
First Semester, S.Y. 2021-2022
HUMAN ANATOMY AND

PHYSIOLOGY
PRELIM LABORATORY SHEETS
1
Davao Doctors College
Medical Laboratory Science Program
HUMAN ANATOMY AND PHYSIOLOGY

ACTIVITY NO. 1
The Language of
Anatomy
Names: ____LLABORE, CHRISTINE JOY C. ______________
________________________________________________
________________________________________________SCORE:
Course/Yr. /Sec.: _______________ Group No. _____________ Date

Performed: _______________ Date Submitted: _________
General Instruction:
✔ The name of the student/s who answered EACH question must appear in the
‘student contributor/s’ to ensure that all students in that group have contributed to
the answering of the lab sheets.
✔ Answers should be PARAPHRASED and not copy pasted from internet or book
sources. It must be PROPERLY cited at the end of EACH question.
Scoring: n (total number of points) + 10 (format) + 10 (equal student contribution)
LEARNING OUTCOME EVALUATION:

1. What is the importance of learning the language of anatomy?
(10 points)
Student Contributor/s:
2
Source/s:
2. Draw a human body (anterior & posterior) label appropriate body landmarks
using anatomical terms. (20 points)
ANTERIOR POSTERIOR
Source/s:
3. Identify the body planes and sections. (5 points)
1. SAGITTAL PLANE 2. FRONTAL PLANE 3. TRANSVERSE PLANE

Student Contributor/s: Llabore, Christine Joy C.
Source/s: Seeley’s Essentials of Anatomy & Physiology 10th edition book.
3
4. Name the anatomical terminology being defined and provide example on the use
of such terminology.(1 point per term and 2 points per example; 33 points)
TERM EXAMPLE
1.SUPERIOR 1.The forehead is

superior to the chest.
2. The mouth is
inferior to the nose.
2.INFERIOR
3. The teeth are

anterior to the throat.
3.ANTERIOR
4. The brain is
posterior to the eye.
4.POSTERIOR
EXAMPLE
TERM
5. The sternum is
5.MEDIAL medial to the chest.
6. The legs are lateral

6.LATERAL to the pelvis.
7. The abdomen is
7.INTERMIDIATE intermediate between
the chest and hip.
8.The talus is
8.PROXIMAL
proximal to the digital.
4
9. The pelvic is distal
9.DISTAL to the dorsum.
10. The hair

superficial to the brain.
10.SUPERFICIAL
11. The brain is deep

to the skull.
11.DEEP
Source/s: Seeley’s Essentials of Anatomy & Physiology 10 th edition book.
5. Name the body cavities, and indicate important organs in each cavity. (26 points)
5
Source/s:
6. List on the table below the important organs of each body cavity. (25 points)
A B C D E
Source/s:

6
ACTIVITY NO. 2
Organ System
Overview
Names: ______ LLABORE, CHRISTINE JOY C. ___________________
________________________________________________
________________________________________________SCORE:


1.Name the Organ system and its function. (60 points)
A. INTEGUMENTARY SYSTEM B. SKELETAL SYSTEM C. MUSCULAR SYSTEM
A. INTEGUMENTARY SYSTEM
7
Function: Provides protection, regulates temperature, prevents water loss, and
helps produce vitamin D. Consists of skin, hair, nails, sebaceous glands and sweat
glands.
B. SKELETAL SYSTEM
Function: Provides protection and support, allows body movements, produces
blood cells, and stores minerals and adipose tissue. Consists of bones, associated
cartilages, ligaments and joints.
C. MUSCULAR SYSTEM
Function: Produces body movements, maintains posture, and produces body heat.
Consists of muscles attached to the skeleton by tendons.
D. NERVOUS SYSTEM E. ENDOCRINE SYSTEM F. CARDIOVASCULAR SYSTEM
D.NERVOUS SYSTEM
Function: A major regulatory system that detects sensations and control movements,
physiological processes, and intellectual functions. Consists of the brain, spinal cord,
nerves, and sensory receptors.
E. ENDOCRINE SYSTEM
FUNCTION: A major regulatory system that influences metabolism, growth reproduction
and many other functions. Consists of endocrine glands such as the pituitary, that
secrete hormones.
F. CARDIOVASCULAR SYSTEM
Functions: Transport nutrients, waste products gases, and hormones throughout the
body; plays a role in the immune response and the regulation of body temperature.
Consists of the heart, blood vessels, and blood.
8
G. LYMPHATIC SYSTEM H. RESPIRATORY SYSTEM I. DIGESTIVE SYSTEM
G. LYMPHATIC SYSTEM
FUCNTION: Removes foreign substances from the blood and lymph, combats disease,
maintains tissue fluid balance, and absorbs dietary fats from the digestive tract.
Consists of the lymphatic vessels, lymph nodes, and other lymphatic organs.
H. RESPIRATORY SYSTEM
FUNCTION: Exchanges oxygen and carbon dioxide between the blood and air and
regulates blood pH. Consists of the lungs and respiratory passages.
I. DIGESTIVE SYSTEM
FUNCTION: Performs the mechanical and chemical processes of digestion, absorption
of nutrients, and elimination of wastes. Consists of the mouth, esophagus, stomach,
intestines, and accessory organs.
9
J. URINARY SYSTEM K. MALE REPRODUCTIVE SYSTEM
L. FEMALE REPRODUCTIVE SYSTEM
J. URINARY SYSTEM
FUNCTION: Removes wastes products from the blood and regulates blood pH, ion
balance and water balance. Consists of the kidneys urinary bladder, and ureters.
K. MALE REPRODUCTIVE SYSTEM

FUNCTION: Produces and transfers sperm cells to the female and produces hormones
that influence sexual functions and behaviors. Consists of the testes, accessory
structures, ducts and penis.
L. FEMALE REPRODUCTIVE SYSTEM

FUNCTION: Produces oocytes and is the sight of fertilization and fetal development;
produces milk for the newborn; produces hormones that influence sexual function and
behaviors. Consists of the ovaries, uterine tubes, uterus, vagina, mammary glands and
associated structures.

Source/s: Seeley’s Essentials of Anatomy & Physiology 10th edition book.

10
ACTIVITY NO. 3
The
Microscope
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1.Draw and label the parts of a MICROSCOPE and list the function of each part. (40
points)
PARTS FUNCTION
11
Source/s:

ACTIVITY NO. 4
The Cell
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:
12

1. Draw a generalized cell and label the cellular regions and cytoplasmic organelles.
(40 points)
No Cell Structure Function(s)
.
1
10
11
12
13
14
13
15
16
17
18
19
20
Source/s:
2. Define interphase, mitosis, and cytokinesis, and list and describe the stages of
mitosis.(35 points)
No. Term Definition

1 Interphase
2 Mitosis
3 Cytokinesis
No Stages of Description
. mitosis
1
14
5
Source/s:
3. Draw the stages of mitosis.(25 points)
15
Source/s:

Department
HUMAN ANATOMY AND

PHYSIOLOGY
16
MIDTERM LABORATORY SHEETS
ACTIVITY NO. 5
Cell Membrane Transport Mechanism
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:
Course/Yr. /Sec.: _______________ Group No. _____________

Date Performed: _______________ Date Submitted: _________

1. Describe processes that move substances across the plasma
membrane, and indicate the driving force for each. (21 points)
No Transport Mechanism Description
.
1
17
Source/s:
2. Compare and Contrast Membrane Transport Processes. (20 points)
Membrane Transport Similarities Differences
processes
Simple diffusion
Osmosis
Simple diffusion
Facilitated diffusion
Active transport
Facilitated diffusion
Filtration
Osmosis
Pinocytosis
Receptor-mediated
endocytosis
Source/s:
18
ACTIVITY NO. 6
Classification of
Tissues
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. Draw the different epithelia in the body and list their general structural
characteristics, functions, and locations. (60 points)
1 2
Simple Squamous Simple Cuboidal
19
3 4
Simple Columnar Pseudostratified Columnar

5 6
Stratified Squamous Transitional

No Description Location Function
. or
Organ
Examples
1.
2.
20
3.
4.
5.
6.
Source/s:
2. Draw the different connective tissue in the body and List the general structural
characteristics, functions, and locations. (80 points)
1 2
Areolar Adipose
21
3 4
Reticular Elastic
5 6
Hyaline Fibrocartilage
22
7 8
Bone Blood
No Description Location or Function

. Organ
Example
1.
2.
3.
23
4.
5.
6.
7.
8.
Source/s:
3. Draw the different muscle type and List the general structural characteristics,
functions, and locations. (30 points)
24
1 2 3
Skeletal Muscle Cardiac Muscle Smooth Muscle
No. Description Location or Function

Organ Example
1.
2.
3.
Source/s:
4. Draw a nerve tissue and List the general structural characteristics, functions, and
locations. (10 points)
25
Nervous Tissue
No Description Location or Function
. Organ
Example
1.
Source/s:
26
Davao Doctors College Medical Laboratory
Science Program
ACTIVITY NO. 7
The Skeletal
System
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. List and explain the six primary functions of the skeletal system. (10 points)
Source/s:
2. List the major components of the axial and appendicular skeleton. (10 points)
27
Source/s:
3. State the specific functions each of the axial and appendicular divisions. (10
points)
Source/s:
4. Classify bones of the human skeletal system based on their shape. Give two
examples of each group. (10 points)
Source/s:
5. Describe the microscopic structure of bone. (5 points)
Source/s:
6. Discuss the role of hormones and bone cells in bone remodeling. (10 points)
Source/s:
7. Cite the regions of the vertebral column and list the number vertebrae in each
region of the adult vertebral column. (5 points)
28
Source/s:
8. List the bones that form the cranium and the sutures that join them. (5 points)
Source/s:
9. Explain the importance of fontanels in the fetal skeleton. (10 points)
Source/s:
10. Distinguish between endochondrial and intramembranous bone development. (10

points)
Source/s:
11. Describe the different criteria that contribute to how skeletal muscles are named.
(5 points)
Source/s:
12. What would happen to skeletal muscle if the epimysium were destroyed? (10
points)
29
Source/s:
13. Describe how tendons facilitate body movement. (10 points)
Source/s:
14. What are the five primary functions of skeletal muscle? (10 points)
Source/s:

Department
HUMAN ANATOMY AND
PHYSIOLOGY
30
PRE-FINAL LABORATORY SHEETS
ACTIVITY NO. 8
Blood
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. Complete the illustration, description, and normal value of each cell. (70 points)
Cell Type Illustration Description and Normal Value
Basophils
Eosinophils
31
Lymphocyte
s
Monocytes
Neutrophils
Platelets
Erythrocytes
Source/s:
2. What are the two major blood antigen groups that are medically relevant and
why? (10 points)
Source/s:
3. What is present in blood plasma that can react with antigens on the surface of
red blood cells? (5 points)
32
Source/s:
4. Briefly describe the appearance of a blood typing test that has reacted and
produced a positive result. (10 points)
Source/s:
5. Which blood type is the universal donor? Explain why. (10 points)
Source/s:
6. Which blood type is the universal acceptor? Explain why. (10 points)
Source/s:
7. Why is it acceptable to give O+ blood to a patient that has B+ blood? (10 points)
33
Source/s:
8. What is hematocrit? (5 points)
Source/s:
9. Why is hematocrit an important diagnostic value for physicians? (10 points)
Source/s:
34
ACTIVITY NO. 9
Structures of the
Heart
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. Complete the following labels. (60 points)
a. Label the prominent coronary surface vessels.
35
b. Label the internal formations of the heart.
36
c. Label the surface features of the anterior aspect
of the heart.
d. Label the surface features on the posterior

aspect of the heart.
37
Source/s:
2. List the function of each cardiac layer and number the order from most to least
superficial. (8 points)
a. Pericardium:
b. Myocardium:
c. Endocardium:
d. Epicardium:
Source/s:
3. Explain why the left ventricle’s walls are thicker than the right ventricle’s wall. (10
points)
38
Source/s:
4. What is the anatomical significance of the pericardium and epicardial fat? (10
points)
Source/s:
5. How does exercise affect pulse rate and blood pressure? (5 points)
Source/s:
6. Explain what happened to the circulatory system during exercise. Include the
major organs involved in your explanation. (10 points)
Source/s:
7. How and why does heart rate change with body position? (10 points)
Source/s:
39
ACTIVITY NO. 10
The Lymphatic
System
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. Sketch the following lymphatic structure histology in the spaces below. List the
cells in each structure, as well as the tissue types and any special/unique
features. (50 points)
a. Bone Marrow
40
b. Thymus
c. Spleen
d. Lymph Node
e. Tonsil Student Contributor/s: Source/s:
2. What is immunological immunity? (5 points)
Source/s:
41
3. What is the function of the lymphatic vessels? (5 points)
Source/s:
4. What is the function of B cells in the immune response? (5 points) Student
Contributor/s: Source/s:
5. What are Antibodies? (5 points)
Source/s:
6. What is an Antigen? (5 points)
Source/s:
7. How do Lymphatic Capillaries differ from blood capillaries? (5 points)
42
Source/s:
8. What structural characteristics ensures a slow flow of lymph through a lymph
node? (5 points) Student Contributor/s: Source/s:
9. What similarities in structure and function are found in the lymph nodes, spleen
and tonsils? (5 points)
Source/s:
ao Doctors College
Department
43
HUMAN ANATOMY AND
PHYSIOLOGY
FINAL LABORATORY SHEETS
ACTIVITY NO. 11
The Respiratory
System
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. Match the respiratory system structure to its proper definition and/or function. (20
points)
No Answe Structure Description
. r
1 Carina A. this tube splits from the main bronchi and serves a
lobe of the lung
2 Trachea B. Region of the throat from the posterior nasal cavity
down to the soft palate
3 Epiglottis C. Ring of cartilage that sits at the superior edge of
the trachea, posterior protrusion provides support for
vocal cord cartilages
44
4 Glottis D. visible externally as the Adam’s apple, thick
cartilage that protrudes anteriorly in the larynx
5 Thyroid E. highly sensitive cartilage structure located at the
cartilage branching point at the inferior end of the trachea
6 Cricoid cartilage F. clusters of individual alveoli that perform gas

exchange
7 Arytenoid & G. smallest diameter tubes that carry air, do NOT
Corniculate contain cartilage, resulting in constriction and dilation
cartilages just like in arterioles
8 Primary (main) H. Region of the throat from soft palate down to

bronchi epiglottis
9 Secondary I. wide, inferior border of the lung; sits on the
(lobar) bronchi diaphragm inferiorly
10 J. small, flexible elastic cartilage structure covered

with taste buds; opens and closes to allow air only to
Tertiary bronchi enter
11 Bronchioles K. Air enters the nasal cavity through these openings
12 Alveolar sacs L. superior to the superior thoracic aperture (the 1 st rib)
13 Larynx M. visible on the posterior aspect and connect the

vocal cords for movement and sound production
14 Nasal conchae N. region of the throat that connects the oropharynx to
the openings of both the larynx and esophagus
15 Nasopharynx O. large diameter tube that allows air to enter each
lung at the hilum
16 Oropharynx P. complicated structure of nine cartilages connected
by membranes and ligaments; houses vocal cords;
‘voice box’
17 Laryngopharyn Q. also known as the windpipe, this structure carries
x air from below the larynx into the thoracic cavity
18 Nares R. Three bony mucous covered shelves protrude from
the lateral wall of the nasal cavity
19 Apex S. superior opening of the larynx containing the vocal
cords
20 Base T. these tubes arise from the secondary as branching
continues eventually reaching bronchioles
45
Source/s:
2. Label the following structures.

a. Larynx. (16 points)
b. Respiratory system. (10 points)
46
c. Sagittal view of the upper respiratory system. (5 points)
Source/s:
3. Write the route that oxygen takes from when you inhale to the point of gas
exchange with carbon dioxide. (5 points)
47
Source/s:
4. Give two unique characteristics of the pulmonary artery and vein. (5 points)
Source/s:
5. Describe the route of pulmonary circulation. (5 points)

Source/s:
6. Give the importance and functions of the respiratory system. (5 points)
Source/s:
7. Name five major organs involve in the respiratory system and describe each
contribution in the system. (10 points)
Source/s:
8. Describe the three regions of the pharynx and their functions. (10 points)
48
Source/s:
9. If a person sustains an injury to the epiglottis, what would be the physiological
result? (15 points)
Source/s:
10. Compare and contrast the conducting and respiratory zones. (10 points)
Source/s:
49
ACTIVITY NO. 12
The Digestive
System
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:


1. Label all digestive organs of the GI tract.
50
2. Label the elements of the alimentary canal.
3. Label the different aspects of the mouth.
51
4. Label the major salivary glands and ducts.
5. Label the aspects of the stomach accordingly.

52
6. Label the accessory organs, structures, and ducts of the digestive system.
7. Label the structures and features of the large intestine.
53
Source/s:
8. Describe the pathway food takes upon ingesting it, making sure to include all
accessory structures.
(5 points)
Source/s:
9. Explain the differences between the layers of the gastrointestinal tract. (5 points)
Source/s:
10. List each type of tooth. How do they function during mastication? (5 points)
54
Source/s:
11. List the accessory and primary structures of the GI tract. Why would accessory
structures not be classified as primary organs/structures of the digestive system?
(5 points)
Source/s:
12. Offer a theory to explain why segmentation occurs and peristalsis slows in the
small intestine. (5 points)
Source/s:
13. Explain how the stomach is protected from self-digestion and why this is
necessary. (5 points)
Source/s:
14. Describe unique anatomical features that enable the stomach to perform
digestive functions. (5 points)
55
Source/s:
15. Explain how nutrients absorbed in the small intestine pass into the general
circulation. (5 points)
Source/s:
16. Why is it important that chyme from the stomach is delivered to the small
intestine slowly and in small amounts?
Source/s:
17. Describe three of the differences between the walls of the large and small
intestines.
Source/s:
56
ACTIVITY NO. 13
The Reproductive
System
Names: ________________________________________________
________________________________________________
________________________________________________SCORE:

1. Match the structure of the reproductive system to its proper description. (15
points)
No Answe Structure Description
. r
1 Testes A. connective tissue structure that holds the female
reproductive organs in place in the pelvic cavity
2 Ovaries B. fingerlike projections from the fallopian tube that assist ova
in entering the tube
3 Uterus C. primary reproductive organ that produces and matures

sperm cells and testosterone
4 Prostate D. pair of skin folds that help protect the opening of the vagina
gland in the perineal region
5 Penis E. sac that hangs at the root of the penis and holds the testes
57
6 Vagina F. primary reproductive organ that produces and matures ova
and estrogen/progesterone
7 Epididymis G. produces seminal fluids and can be palpated through the

anterior wall of the rectum
8 Uterine H. tubes connect the uterus with the peritoneal cavity near
(fallopian) each ovary
tube
9 Cervix I. structure that sits posterior to the testes within the scrotum,
stores sperm until fully matured
10 Seminal J. copulatory organ of reproduction that contains erectile

vesicle bodies to assist distribution of sperm
11 Ductus (vas) K. muscular organ that is known as the womb; connects
deferens fallopian tubes to the vagina
12 Labia majora L. produces seminal fluids and is located on the posterior

& minora aspect of the bladder; joins the vas deferens to the ejaculatory
duct
13 Scrotum M. copulatory organ of female reproduction, also known as
the birth canal
14 Fimbriae N. tube enters the abdomen and travels along the base of the
bladder and transports sperm
15 Broad O. inferior opening of the uterus, contains glands that help

ligament lubricate the vagina
Source/s:
58
2. Complete the labels.
a. Parts of the male urinary/reproductive
systems. (15 points)
b. Parts of the female reproductive system. (13

points)
59
c. The breasts. (5 points)
d. The uterus. (5 points)
60
Source/s:
3. What special features are evident in sperm cells but not in somatic cells, and how
do these specializations function? (5 points)
Source/s:
4. What do each of the three male accessory glands contribute to the semen? (5
points)
Source/s:
5. Describe how penile erection occurs. (5 points)
Source/s:
6. While anabolic steroids (synthetic testosterone) bulk up muscles, they can also
affect testosterone production in the testis. Using what you know about negative
feedback, describe what would happen to testosterone production in the testis if
a male takes large amounts of synthetic testosterone. (15 points)
61
Source/s:
7. Follow the path of ejaculated sperm from the vagina to the oocyte. Include all
structures of the female reproductive tract that the sperm must swim through to
reach the egg. (5 points)
Source/s:
8. Identify some differences between meiosis in men and women. (5 points)
Source/s:
9. Explain the hormonal regulation of the phases of the menstrual cycle. (10 points)
Source/s:
10. Endometriosis is a disorder in which endometrial cells implant and proliferate

outside of the uterus—in the uterine tubes, on the ovaries, or even in the pelvic
cavity. Offer a theory as to why endometriosis increases a woman’s risk of
infertility. (15 points)
62
Source/s:
63

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ao Doctors College

Medical Laboratory Science

HUMAN ANATOMY AND

HUMAN ANATOMY AND PHYSIOLOGY

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

3. Identify the body planes and sections. (5 points)

1. SAGITTAL PLANE 2. FRONTAL PLANE 3. TRANSVERSE PLANE

1.SUPERIOR 1.The forehead is

3. The teeth are

6. The legs are lateral

10. The hair

11. The brain is deep

Davao Doctors College

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

A. INTEGUMENTARY SYSTEM B. SKELETAL SYSTEM C. MUSCULAR SYSTEM

D. NERVOUS SYSTEM E. ENDOCRINE SYSTEM F. CARDIOVASCULAR SYSTEM

K. MALE REPRODUCTIVE SYSTEM

L. FEMALE REPRODUCTIVE SYSTEM

Student Contributor/s: Llabore, Christine Joy C.

Davao Doctors College

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

Davao Doctors College

LEARNING OUTCOME EVALUATION:

No. Term Definition

Davao Doctors College

HUMAN ANATOMY AND

Course/Yr. /Sec.: _______________ Group No. _____________

LEARNING OUTCOME EVALUATION:

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

Simple Squamous Simple Cuboidal

Simple Columnar Pseudostratified Columnar

Stratified Squamous Transitional

No Description Location or Function

Skeletal Muscle Cardiac Muscle Smooth Muscle

No. Description Location or Function

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

5. Describe the microscopic structure of bone. (5 points)

9. Explain the importance of fontanels in the fetal skeleton. (10 points)

10. Distinguish between endochondrial and intramembranous bone development. (10

13. Describe how tendons facilitate body movement. (10 points)

Davao Doctors College

Course/Yr. /Sec.: _______________ Group No. _____________

LEARNING OUTCOME EVALUATION:

9. Why is hematocrit an important diagnostic value for physicians? (10 points)

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

d. Label the surface features on the posterior

Course/Yr. /Sec.: _______________ Group No. _____________ Date

LEARNING OUTCOME EVALUATION:

e. Tonsil Student Contributor/s: Source/s:

2. What is immunological immunity? (5 points)

5. What are Antibodies? (5 points)

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _ Date

Course/Yr. /Sec.: ___ Group No. _

Course/Yr. /Sec.: ___ Group No. _ Date