Student's Name: _______________________________________________

Address: ______________________________________________________

City/Province: _____________________ Postal Code: ________________

Phone: (___)_______________________ E-Mail: _____________________

School Name: __________________________________________________

Address: ______________________________________________________

City/Province: _____________________Postal Code: _________________

Student's Current Grade Level: ___________________________

Name of FSL Teacher: ___________________________________

PARENTAL AGREEMENT

This is to certify that I am the parent and/or guardian of the above-named student, and agree that s/he may participate in promotional activity with Canadian Parents for French.

Signature: _________________________ Name: _________________________

STUDENT CERTIFICATION

I hereby certify that the enclosed essay is my own original work, written in French, and that I am enrolled in a French as a Second Language program in this academic year.Furthermore, I attest that I have reached a minimum Grade 10 level in high school but have not yet graduated, and agree to participate in promotional activities with CPF.I certify that my first language is not French.

Signature: _______________________

Date: ___________________________