1. education
2. school

APPLICATION COVER SHEET
High School Equivalency Program
APPLICA nON
RECEIVED:
CLASS TlME:
_
10#
NAME:
~-------------
HOME CAMPUS: __
DOCUMENTS:
-'~7~--------
_
D08:
_ AGE:
INCLUDED
_
NEEDED
Secondary Enrollment Form
GED Program Rules
Parent Agreement Form'
Consent to Test
Attendance Form(yeIlow)
Secondary Health Information
GED Test Center- Information
1a
Proof of Residency
Transcript
SS Card
Withdrawal
Court Ordered: Yes'
2a
Age at the beginning of the school year:
2 b
Risk Factors:
(2) __
No
(Must indude
(If 'Yes' indude do~umen( and skip 2)
(Must be 16 or above)
one of the following risk factors)
did not pass the semester in two or more subjects of the core curriculum
in the
preceding
or current
school year;
(3) __
was not advanced from one grade level to the next for one or more school years;
(4) __
did not perform satisfactorily
.
assessment
.
instrument
on one or more sections of the most recent state administered
(TAAS)
(5) __
is pregnant or is a parent;
(6) __
has been placed in an alternative
(7) __
has been expelled during the preceding or current school year,
education program during the preceding or current school year;
(8) __
is currently on parole, probation, deferred prosecution,
(9) __
was previously reported through the PEIMS to have dropped out of school;
or other conditional
release;
( 10) __
is a student of limited English proficiency;
(11) __
is in the custody of DPRS or has been referred by a school official, juvenile court, or law enforcement
official to-the DPRS during the school year;
(12) __
is homeless;
(13 )__
resided in the preceding
school year or the current school year in a residential placement
the district, including a detention facility, substance
psychiatric
Parent written consent:
2 d
Year originally
Yes
No _
2 e
Total number of high school credits:
2 f
Pre-test score:
enrolled in 9'h grade:
(Must be
Has taken the exit level assessment:
Yes__
Yes__
(Must have parent written consent)
August
(Two years must have elapsed)
(Must be less than 6)
::>
8 grade level)
Yes
No
No__
No
If "No"does not qualified because:
COMMENTS
shelter,
hospital, halfway house, or foster group home.
2 c
ENROLL:
abuse treatment facility, emergency
facility in
AND RECOMMENDATIONS
If No when do you plan to take it?
Reviewed by
Reviewed by
Date:
Date:
_
_
_
Venture School
4QOOWest Arkansas Lane • Arlington.
HIGH SCHOOL EQUIVALENCY PREPARATORY
PARENTAL AGREEMENT FORM
Texas 7hO 16· (SI7) 492-6400
FAX: (817)492·6405
CLASS
The certificate of General Educational Development (GED) is an alternative
to a high school diploma. The Arlington Independent School District offers
GED preparatory classes at Venture School for persons seventeen to twentyone years of age who have not obtained a high school diploma and are not
enrolled in school.
Persons who are seventeen years of age must have parental consent to enroll
in classes and to take the test
I give my permission for my child,
who is
years of age to enroll in the GED Preparatory
_
Classes.
Parent or Guardian Signature
Date
Student Signature
Date
ARLINGTON
INDEPENDENT
S.CHOOL DISTRICT
"Quality In Action"
Page 2 of2
Texas Education Agency
PARENT I GUARDIAN CONSENT
TO TAKE THE TESTS OF
GENERAL EDUCATION DEVELOPMENT
(GED)
(To be completed by parent/guardian of 17-year-old applicant)
My son/daughter,
, is not enrolled in school and has my
permission to take the General Educational Development (OED) Tests.
If passing scores are obtained
on the tests, I understand that a Texas Certificate of High School Equivalency will be issued.
Name of School My Son/Daughter
I,
-:-=-_--::
~-----'
Last Attended
authorize the OED Chief Examiner to verify
(Parent's name)
with the above named school, or any other school that my son/daughter has attended, the current
enrollment status of my child. I authorize any school attended by my son/daughter to release to the
OED Chief Examiner any information necessary to confirm current enrollment status, including
information other wise made confidential under the Family Education Rights and Privacy Act, 20 U.S.c.
Section 1232g.
I understand that if the information provided on this form is found to be incorrect, the testing
center GED Chief Examiner can refuse to administer or score the GED tests and the state can
refuse to issue a score report or high school equivalency certificate based on your son's/daughter's
tests results.
Parent I Guardian Signature
Date
".,
.
.'
.".
Texas Education Agency
Page 1 of2
Texas Education Agency
Continuing Education and School Improvement
OED Test Administration Withdrawal Form
For 17 Year Olds
o
.
.
This withdrawal form must be completed for seventeen (17) year olds who are seeking to tske the
General Educational Development (GED) test and are not enrolled in an approved High School
Equivalency Program (HSEP).
Please Print
Student Information:
Last Name
First Name
Middle Name
~
.I
1
(MonthlDay/Y r)
Date of Birth
Social Security Number
------.1
/
Maideh Name
_
Age
_
(MonthiDay/Y r)
Date Withdrawn from Schoo I
Has this student been enrolled in an approved HSEP for any length of time after January I, 2002?
D
D
Yes*
No
*If an individual has been enrolled in an approved HSEP after January 1, 2002, but is not
currently enrolled in an HSEP, then the individual may not test prior to his/her 18th birthday,
unless the student has taken all required assessment instrument at another school.
School Information:
School Campus Name
School District Name
County-District # .
.'1.:
Campus Principal or Designee
Signature of Principal or Designee
Date of Signature
.j;
..;....
hrtnv/www
tf':;:tst~tf':txlls/PNl/follns/(JF.nWithcir;:twH
iphSchoolFoml
htm
1I111?OOR
Venture School GED Program
Rules
All GED students must adhere to A.I.S.D. rules regarding the following:
TobaccolLighters
..
• No cigarettes, no lighters, no smoking on school grounds.
• Cigarettes and/or lighters will be confiscated if student isfound in
possession of them.
Cell Phones
•
•
Students are authorized to possess cell phones and other electronic
communication devices on a school campus; however, phones or other
electronic devices must be switched off during class time.
School is not responsible for damage, loss or theft. Students are reminded
that any school authority has the right to require phones or electronic
devices to be turned off while school business is begin conducted.
Attendance Policy
• If you are absent 3 days in a row, you may be withdrawn from class.
• If you are not present 80% of the time, you may be withdrawn from class.
Dress Code
•
All Venture School Dress Codes regulations will be enforced.
Behavior
•
Students are expected to follow A.I.S.D. rules. Violation of rules may
result in immediate withdrawal from the GED class.
•
Students are expected to respect Venture rules, others, and themselves.
Inappropriate language used in the classroom and/or toward the teacher
will result in immediate withdrawal.
I agree to follow all A.I.S.D. and Venture rules and guidelines. I understand that I may
be withdrawn from the GED class if I violate any of the above rules and guidelines.
I have received a copy of the A.I.S.D. Student Dress Code. ---Initials
Student Signature:
------------------Date:
---------
THE STUDENT DRESS CODE
A student's conduct is related to his/her clothing. Therefore, the school is directly
concerned with the student's clothing. The appropriateness of a student's clothing for
the school environment should dictate the choice of clothing and grooming practices on
each given day.
All students are expected to adhere to common practices of modesty, cleanliness
and neatness; to dress in a respectful manner within the acceptable standards of
the community and in such a manner as to contribute to the academic
atmosphere, not detract from it. Students who fail to comply with this dress code
may be sent home and be subject to disciplinary actions.
Any clothing, accessories, symbols, jewelry, or other paraphernalia, which depicts or
suggests association with a gang, secret society, or fraternity, shall not be brought to
school, worn at school, or in any way be present at any school-sponsored event.
ANY OTHER CONSIDERATIONS WILL BE DETERMINED BY THE INDIVIDUAL
SCHOOL ADMINISTRATORS. THE SCHOOL ADMINISTRATION SHALL HAVE THE
RIGHT TO CONSIDER ANY CURRENT FASHION TO DETERMINE ITS
ACCEPTABILITY FOR SCHOOL WEAR.
Clarification regarding apparel should be obtained PRIOR TO WEARING IT TO
SCHOOL; this can be obtained from the school administration. Students in violation of
this policy will be subject to disciplinary action as determined by the school's
administration.
Teachers are charged with the responsibility of enforcing student dress code in their
classes as well as on campus. Administrators and other school personnel share the
same responsibility. Teachers shall follow building procedure for discipline referral
regarding dress code violations.
No attempt will be made to dictate fashion styles as long as they are in keeping with
district policies. It should be noted, however, that it is the responsibility of the student
and parent that the student adhere to the dress code, as follows:
GENERAL:
Any clothing, jewelry or accessories with decorations, patches, lettering,
advertisements, etc., that may be considered obscene or offensive are not to be worn to
school. This includes any clothing, jewelry, accessories that may be used as weapons,
accessories having drug, sexual emblems, tobacco or alcoholic beverage references or
.designs.
Form-Fitting garments such as spandex may only be worn with another layer of
clothing, which meets the dress code.
SHIRTS & BLOUSES
Crop tops, tube tops, halters and spaghetti straps are unacceptable (anythingless than 2
inchesis considereda spaghetti strap.) Strapless dresses without jackets are
unacceptable.
The length of an untucked shirt must be no longer than the tip of the longest finger with
the student's hand fully extended down the side of the student's leg.
32
.-- -~:7' - .._..•. -....
- ...-•.•.•-;"....
Transparent and/or see through material is considered unacceptable.
Shirts/tops must
touch the waist of pants/skirts at all times (i.e. when in movement, when arms are
extended or raised, and when in seated position, etc.) Low-cut tops or blouses are
inappropriate.
At the secondary
y
;/
I
1
I
!
DRESSES,
level, a boy's shirt should cover the entire crown of the shoulder.
SKIRTS:
The length of a skirt/dress must be a minimum of half the distance between the
fingertips and the top of the knee when the student's hand is fully extended down the
side of the student's leg.
When measuring skirts, dresses, or shorts/skorts that have slits, the length will be
determined by measuring from the top of the slit.
SHORTS, SKORTS
The minimum length of shorts/skorts must be no shorter than the tip of the longest
finger with student's hand fully extended down the side of the student's leg.
PANTS:
Intentionally torn or cut/slashed
cut slits are acceptable.
t-,
:rI
SAGGING
pants are considered inappropriate.
Manufactured
boot-
PANTS:
.1
No Sagging.
Students shall wear their trousers or overalls properly at the waist.
ACCESSORIES:
All students must wear shoes.
Students should wear athletic footwear in order to participate in any physical education
class.
Hair should be kept neat, clean, and reasonably
styled.
Any type of head covering is unacceptable.
Religious exceptions
must be cleared by the principal.
Proper undergarments
should be worn but not visible.
Facial hair should be neat, clean, closely trimmed and not be a distraction
learning environment.
Chains or spiked jewelry are unacceptable.
Pierced body ornaments
are restricted to the ear.
33
to the
Venture School
General Educational Development (GED)
Arlington Independent School District
Name
Previous School
Parent/Guardian
Age Sept. 1sT
_
-------------------------Zip
Business
Class Time
_
Sex ---
Grade ----
Home Phone
-----------
Cell Phone
Mother's Business
--------------
----------------------------------
-------------Texas 10: Yes --WD:
Date TAKS Taken: ------
20 --
I
2
3
4
5
6
7
8
9
10
September
October
November
December
20__
January
February
March
April
May
June
absent
"120"
=
minutes in class, etc.
"W = Holiday
Court Order: Yes -----
No --No
Yes__
August
=
_
_
Date 9th Grade Entry ------
"A"
Ethnic Code ---
-----
Address
Father's
_
Social Security #
-----------------------------------
Date of Birth
Entry Date
AlSO 10 No. ------
-------------------------------------------------
II
12
No ---
_
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Totals
ABTD
Arlington Independent School District
Secondary Health Information
Date'---
Grade'---
Age
Advisor
_
Student~
Birthdate
Address.
Home Phone'--
ParentiGuardian,
Wk Phone'--
_
_
Pager__
"--
_
~tSchooIAttended,
_
Name of School District Transferring.From,
(If other than Arlington ISD)
School Address'--
_
_
Medicallnforrnation: It is important that school staff have vital information to be able to deal with emergencies. Docs
the student have any of the following conditions:
Attention Deficit__
Depression__
Kidney Disease__
Allergy (Severe>-Diabetes__
Liver Disease__
Anemia__
Eating Disorder_'_
Migraine __
Anxiety Attacks__
Heart Condition_, _
Muscular Dyst.__
Asthma__
High Blood Pressure__
Multiple Sclerosis__
Bipolar Disorder__
Immune Deficiency
Schizophreni~
Cancer__
(HIV, Lupus, etc.)__
Sickle Cell__
Cystic Fibrosis_
. Intestinal Problems__
Seizure Disorder__
Pregnancy__
Due Date
Suicidal Tendency__
Other (if yes, please explain).
Do you wear:
--:-
Glasses__
Contacts__
--'-_--,-
_
Hearing Aid__
Name and dosage of any routine medication given: At Home.__
....:-
_
At School
_
Condition for which medication is received,
_
Person(s) to call in case a parent/guardian cannot be contacted:
1.------------Relationship
.Current Home Phone #
Current Wk. Phone #
Pager Number
_
_
_
_
2.
_
Relationship
Current Home Phone #'-----~
CurrentWk.Phone#
Pager Number
_
_
_
_
[ hereby authorize the school to administer first aid and arrange transportation to a physician or hospital in case of
emergency.; I give consent for my child's
health information
to be shared with
f acu Lty Zata f f on an "as-needed"
basis only.
Signature of Parent or Guardian
Physician
Hospital Preferred:.
-'-
Phone'-"--
_
_
Texas ID
Location:
Texas Driver's License Oftice
3901 W. Arkansas
Corner of Arkansas and Park Springs
I mile WEST of Bowen
Arlington, TX 76016
N.
J03IPioncer
Phone: 817-274-1818
Hours: Monday through Thursday
Friday
Cost: $15.00
7:30 am to 6:00 pm
8:00 am to 5:00 pm
Park Springs
Bring: 3 forms of identification
I. original birth certificate
2. social security card
3. another form ofID
W. ArkansaS
Social Security Card
Location:
Social Security Administration
Northridge Technical Center
2010 North Highway 360 (East side of Hwy 360)
Arlington, TX
1. Take Highway 360 NOl1h
a. Exit Ave K'Brown Blvd.
b. North on service road for about 1 mile
c. Next door to Hampton Inn
Phone~I-800-772-1213
. 972-343-2307
Hours: Monday through Friday
Bring: Call for information.
9:00 am to 4:00 pm
Bowen
{~
Secondary Enrollment Card
~~~~,~~~~~
<.L
More Than a Remarkable Education
Enroll Date:
Enrollment Card Accepted By:
Withdrawal/Report Card Requested:
Records Requested:
FOR OFFICE USE ONLY (Office: Record any corrections on this !JJKlthe computer.)
Campus:
Student ID #:
Grade/Homeroom:
Counselor:
Graduation Plan:
Locker:
_
Parents: Please print
in pencil and complete
_
_
T oday's Date:
Fecha De Hay
both sides
Padres De Familia:Escriban con Iclpiz y completen ambos lados
** SpecialNotation (Including Medical,Court/Restraining Orders):
Anotocion Especial (Incluyenda 6rdenes Medicas. De Restriccion. De La Corte)
Student Name:
Nombre Del Estudiante
(LEGAL) First Name Nombre
(LEGAL) Last Name Ape/lido
Generation (jr; II,III,etc.):
_
Generoci6n
Sex:
_
Nickname Apodo
Ml/nicia/
Grade:
Sexo
Grado
SocialSecurity #: -,--",-
(OFFICE ONLY: PEIMSAlternate ID #): S
_
_
Numero De Seguro Social #
Copy of SSN Card Provided?
Y
N
Copy of Birth Certificate?
d'rovey6 Copia De La Ioqeu: del SSN?
Si
No
iCopia Del Acta De Nacimiento?
Date of Birth:
N
Copy of Immunizations?
Si
No
iCopia De Las Vocunas7
Y
N
Si--
No
Birthg,lace:
Month/DaylYear MesiDialAiio
Fecha De Noatmenu:
Y
Lugar e Nocimiento
Home Phone #:
CityGudad
State
Eszooo
Pais
Country
DUnlisted
Numero De Te/efono
Sin Lstar En EJDirectorio
Home Language(LanguageSpoken in Student's Home):
Lengua}e Del Hagar (Lenguaje Que Se Habla En La Coso)
Circle the graders) your child has attended in United States schools:
Orwle EJ(Los)Grada(s) Que Su Niiia(a) Asisti6A Oases En Escuelas De Los Estaclas Unidos
Student Is:
Homeless?
Migrant?
EJEstudlOnte
mene Cosa?
iMigrante?
Student ResidesWith:
DFather
DMother
Padre
Madre
EJEstudlante ViveCon
DLegal Guardian
Guardian Legal
PK3 PK4 K
2
3
5
6
City:
Oudad
Proof of ResidencyProvided? Y
N
No
8
9
II
10
12
Otro
Direcci6nDe La Coso ----------------------------------d'rovey6 Prueba De Residencia?
7
DOther:
Home Address:
Si
4
ZiP Code:
Zona Postal
(If proof of residency is in someone else'sname, a ResidencyAffidavit form must be completed.)
(Si la prueba de residencia esrd a nombre de ouo persona debe de completar el Oflcio De Residencia.)
Lease
Utility Bill
Other
Contracto De Renta
Reciba De La Luz
Otro
FIRSTPARENT/GUARDIAN
(Identify only ONE person as legal guandian in this section.ldentifida sola uno persona a su guardian en esto forma.)
Parent/Guardian Name:
Relation:
Legal Guardian? Y
N
Nombre del padre
Parentesco
iGuardian Legal?
No
0
tutor
DUID #:
DaB:
Home Phone #:
Numero de lic-enc-,-la-de.,-m-a-ne""'j,.-a'
•.IN"'u7"·m-e-ro-de...,....,ic/e-;-n'""ufi'/c-oc""i67"n----Fecha De"";N"'oc-,-im""ie-n-to---------------
OCity:
DlfeCci6n
Empleador
udad
Work Phone #:
----------------------------
NumeroDelkabap
ZipCode: ----Zona Postal
Ext.:
----------------------
Cell Phone #: _____________
May we send a text messageto you? Y _
N_
E-mailAddress:
Telefono Celular #
d'cx:iemos enviarie un mensoje en texto a usteel? Si
No
Domicilio de correo electr6nlCo
SECOND PARENT/GUARDIAN
_
Numero De Telefono
Address: ________________________________
Employer:
Si
_
Extensr6n
(Identify only ONE person as legal guardian in tihis section.ldentifrcia sola una persona a su guardan en esto forma.)
Parent/Guardian Name:
Relation:
LegalGuardian? Y
N
Nombre del padre
Porentesco
iGuardian Legal?
No
0
tutor
DUID #:
DaB:
Home Phone #:
Numero de /jc-en-c.,-,o-de.,-m-o-n""'ej-o'
•.IN"'u7"·m-e-ro-de...,....,id""e-n'""u~'/c-ac""i67"n----Fecha De-N:-;a-c.,-im-/e-n-to---------------
_
Numero De Te/efono
Address: ________________________________________________________
City:
ZipCode:
Dlrecci6n
Oudad
Zona Postal
Employer: _______________________
Empleodor
Work Phone #:
Numero Del Trabajo ----------------------
Cell Phone #: _____________
May we send a text messageto you?Y __
N_
E-mailAddress:
Telerono Celular #
d'cx:iemos enviarle un mensoje en texto a usted? Si
No
Domiciliode correo electr6nico
whse# 01.32.0 I07
SI--
_
Ext.:
_
Extensi6n
A-038-S-11
PreviouslyAttended School in the Arlington ISD?Y__
N _
Campus:
iAslsti6 Previomente A La Escuela En Arlington?
No
Plantel escolar
Si
_
Grade(s):
_
Grodo(s)
Student is approved transfer from which AISD campus?
_
De Cual AISD Escuela Esta AprolxxJo Transfero?
LastSchool/District Attended:
Date: _______
Grade(s):
Ulumo Distrito Escolar AI Que Asistio
Fed1a
Grado(s)
Address:
oCity:-----udod
Dlrecoon
State: __
Zip Code: ____
Phone #:
Estado
Zona Postol
TeJe(ono
_
If student hasever received any of the following special services,indicate in which grade(s).
Si el estu<!iante ha recibido alguna vez cualquiera de los siguientes servicios especiales indique en que grado(s)
504
Dyslexia
GiftedfTalented
Bilingual
504
Dislexia
Superdotados
Bilingiie
SpecialEd.(check all that apply):
OResource
Edx:006n Especial (marque !ados /os que aplican)
OSpeechTherapy
Recursos
District/School Where ServicesWere Provided:
Name:
DJStrito/EscueloDonde Esws Servicios Fueron Proveidos
Nombre
Repeated a Grade? Y _
iRepiti6 Grado?
Si
N_
No
Student Plansto Attend College? Y
LEI/AI Estudiante Va A Asistir La UniversiQocP Si
_
Dicci6n
ESL
_
_
ESL
OOther (specifythe service provided)
Otro (especifique (as servicios prevefcios)
City/State:
_
_
Cuidod/Estado
Which Grade(s)?
iQue Grodo(s)?
N
No--
Student Is Pregnant? Y
N
Si--
iEsta Emborazado
La Estudiante?
No
Student Is a Parent? Y
N
iEs EJ Estudiante Padre
Madre AHara?
No
o
Names of Other School-Age Children in the Home
Age
Sex
Campus Attending
Nombre de otros niiios de edod escolar en coso
Edod
Sexo 0 genera
Plantel 01 que asiste
Si
I authorize the person(s) listed below to pick up my child during the school day.(Include both parents' names if both are authorized to pick up the child.)
Autorizo a 1'0 persona mencionado abojo a que recoja a mi nino/a durante el dia escoTor.(Esto incluye los nombres de ambos padres si los dos estan autorizados a recoger '01 nino/a).
Personsto Notify in Case of Emergency when Parent or Guardian Is Not Available
La Persona Para NofifJCar En Caso De Emergenico
Name:
Phone:
Nombre
Tele(ono
Name:
Phone:
Nombre
Tele(ono
_ Relationship:
_
Relationship:
Name:
Phone:
Relationship:
Tele(ono
Parentesco
Physician:
Phone:
Tele(ono
_
Parentesco
Nombre
Doctor
_
Parentesco
_
_
I hereby authorize the school to administer first aid and to provide and/or authorize transportation of my child in case of emergency.
Por Medio De La Presente YoAutorizo A La Escuela A Administrar Primeros Auxilios Y transportacion En Coso De Emergenoa
Parent/Guardian Signature:
Date:
hnna Del Padre/Madre/Guardian
Fecha
_
Any person who knowingly falsifies information on a form required for enrollment of a student in a school district commits an offense under section 37.10 of the
TexasPenalCode, which offense is a classA misdemeanor unlessthe person's intent isto defraud or harm another. in which event the offense is a felony of the third
degree. Further.such person is liable to the district if the student is not eligible for enrollment in the district but is enrolled on the basisof the false information. The
person is liable,for the period during which the ineligible student is enrolled, for the greater of: (I) Maximum tuition fee the district may charge under 25.038,Texas
Education Code; or (2) The amount the district has budgeted for each student as maintenance and operation expenses. A classA misdemeanor is punishableby a
fine not to exceed $4,000, and confinement in jail for a term not to exceed one year.or both such a fine and imprisonment A third degree felony is punishableby
a prison sentence for the term of not more than ten years or lessthan two years,and additionally,by a fine not to exceed $10,000.
My signature below confirms I have read and understand the above information and accept the responsibility for any false information conceming the enrollment of
the student
CuolqUJerpersona que a sobiendos (alsiflque in(ormacion en uno (orma requerido pora 10 instruccion de un estooiante en un distrito escolar comete un delito bojo 1'0 seccion 37.10 del C6digo Penal de Texas, este delJtos
es uno (ed1oria de close A a menos que el intento de 1'0 persona sea el de de(rnuclor 0 donor a otra persona, en cuyo coso el delito es uno (elonia del tercer grado. Ademas eso persona es responsible ante el distrito Slel
estu<!iante no es elegible pora inscripcion en el distnto pero file inscrito en bose a 10 (alsa in(ormaci6n. La persona es responsible, por el periad durante el cual el estudiante ineligibleeste inscrito, por 10 contidad mayor de: (I)
La colegiotura maximo queel distnto puede cobrar bojo 1'0 seccion 25.038 del C6digo de Educocion de Texas; (2) La confidad que el distrito ha presupuestado por coda estudiante como gastos de operacion y mantenimiento.
Uno (echoria de close A es costigable con multo que no exceda de $4,000 dolores, y con(inamiento en 1'0 carcel por un termino que no exceda de un ana, 0 ambos 1'0 multo y el encorcelamiento. Uno (elonia del tercer grodo
es cosfigable con un termino de prision de no mas de diez anos 0 menos de dos anos, y adicionalmente uno multo que no exceda de $10,000 dolores.
Mi flrma en 10 porte de abojo conflrma que he leido y comprendido 10 in(ormacion contenida anteriormento y acepto 10 responsabilidad por cualquier in(ormacion (also en 10 que se respeaa a 10 inscripcion del estudionte.
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