Date:

To Whom it May Concern:

My son/daughter (circle one) has my parental permission, as their legal guardian, to take the G.E.D. test at the Coconino Community College.

Student’s Name: Birth Date:

Last School Attended . Please attach a letter from this school, verifying the date of withdrawal.

Read and Initial the following:

Do you solemnly swear, under the penalty of purgery (ARS 12-2221), all aforementioned information is true and correct to the best of your knowledge?

Initial here

Guardian Name (Please Print)

Guardian Signature

STATE OF ARIZONA

COUNTY OF COCONINO

Subscribed and Sworn before me this day of

, by

NOTARY PUBLIC