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LEMI Certification Request Form
Student Full Name:______________________________________
School Name:___________________________________________
Fees enclosed--Check each that applies:
________ $15.00 Key of Liberty
________ $10.00 Sword of Freedom
________ $15.00 Shakespeare Conquest
________ $25.00 Pyramid Project
________ $100.00 Thomas Jefferson Youth Certification
(This form can be sent in each time you complete a scholar project, or at the end of completing them all)
| Scholar Project |
Mentor Signature |
Date Completed |
| Key of Liberty |
|
|
| Sword of Freedom |
|
|
| Shakespeare Conquest |
|
|
| Pyramid Project |
|
|
| PP pre-algebra exam |
|
|
| TJYC 1 and 2 |
|
|
| TJYC 3 |
|
|
In order to certify in Pyramid Project, the pre-algebra exam must be completed and passed. Exam Administrator (Parent or Mentor)
Click here for the exam. Send completed exam in also, showing student's work. Student must achieve 70% or higher for the credit.
Today's Date: __________________________________________
Parent Signature:_______________________________________
Student Signature:_____________________________________
Be sure you have enclosed the following before the deadline of July 15th:
1. This Certification Request Form
2. Certification fees.
3. Include the Pre-algebra exam, if you are certifying in Pyramid Project.
Mail to: LEMI 552 W. 100 N. Blackfoot, Idaho 83221