This course contains knowledge which is vital for a successful life.

NAME: _____________________________ ORG: ____________________

START: _________________________

COMPLETION: ___________________

This Checksheet contains the knowledge vital for survival of Scientology technology from Level 0 and the levels below 0. It covers the technology dealing with ”remembering” and ”communication”.

1. Student Hat

"THE ACADEMY LEVELS CONTAIN SOME OF THE MOST FUNDAMENTAL DISCOVERIES REGARDING LIFE AND THE HUMAN MIND THAT HAVE EVER BEEN DISCOVERED IN THE HISTORY OF THIS UNIVERSE. THEY ARE A BASIC, SWEEPING TRAINING GROUND IN HANDLING LIFE AND PEOPLE." -LRH

NAME:________________________ORG:_________________________

During the course the whole of study technology should be applied. The items of the checksheet must be studied and drilled in the given order. This checksheet is done by going through the materials and the practicals once.

A Hubbard Recognized Scientologist, able to audit others standardly up to Grade 0 Communications Release.

This checksheet contains the vital survival knowledge of Scientology Level II technology. It covers the technology dealing with contrasurvival acts of commission and omission.

The completion of this checksheet entitles you to a certificate as ”Hubbard Recognized Scientologist” (temporarily). The certificate is valid only for year and must then be validated by an internship.

2. A Professional TR Course
3. Provisional Class I
4. Method One Word Clearing

When you have completed your training up to Class IV you should go through your internship in this or a higher organization under the skilled guidance of technical experts. For complete training as an auditor an internship is absolutely necessary. If you then are able to apply the processes of the Grade flublessly, you will get awarded with the full certificate as Hubbard Recognized Scientologist (permanent).

(Method One Word Clearing is a prerequisite for training at this level, except where waived by a qualified C/S as covered in HCO PL 25 Sept. 79RB 11, Rev. 1.7.85, METHOD ONE WORD CLEARING.)

STUDY TECH: Study tech is to be applied in full throughout this course. The materials are to be studied and drilled in sequence. By initialing the blank after each checksheet entry, you are attesting that you fully understand and can apply the data. DRILLS ARE TO BE DONE FULLY TO THEIR RESULT. If you are not a fast flow student, you must star-rate check out on all items marked with an asterisk (*). (Ref. HCOB 13 Aug. 72RA, FAST FLOW TRAINING) The course does not require twinning.

2-3 weeks full time study.

Books: Scientology: The Fundamentals of Thought
The Book of E-Meter Drills
E-Meter Essentials
Dianetics and Scientology Technical Dictionary
Hubbard Certified Auditor course pack
Level II Academy lectures

1. * HCO PL 7 Feb 65 Keeping Scientology Working ______________

The student must have these books, course pack and lectures.

The student also must have his own E-Meter, as it will be needed during this course to do the required drills and auditing.

You are required to maintain a standard course schedule. Study and work during your class periods and outside of class. You have a lot to study and get checked out on in order to complete this course. You can't afford to waste time. You may be credited with materials you have studied on previous checksheets.

TECHNICAL TRAINING FILMS:

1. Dianetics 55! ______________

"THE TECHNICAL TRAINING FILMS ARE DESIGNED SPECIFICALLY TO CLARIFY AND GREATLY IMPROVE AND SPEED THE TRAINING OF AUDITORS." -LRH

These LRH films can help you achieve a high level of skill and certainty as an auditor and are a vital part of Academy training. Before you may graduate from this course, each of the films assigned to it is viewed along with the student body in regularly scheduled showings.

You must also have seen all films assigned to earlier courses before completing this checksheet.

You may view each film as many times as needed to ensure you have fully grasped the tech presented in it. Viewing these films more than once is recommended: Number of times over the material equals certainty and results.

After the first viewing of a single film, you must be word cleared on that film before viewing it again or viewing the next film.

1. HCOB 12 Nov 81RA *Added by Max Hauri Grade Chart for the Lower Grades modernized ______________

PRODUCT: A Hubbard Certified Auditor who is able to audit others to Grade II Relief Release standardly.

CERTIFICATE: On completion of this checksheet you may be awarded a provisional HUBBARD CERTIFIED AUDITOR certificate. A provisional certificate is only valid for one year unless validated by successful completion of the Class IV Internship.

LENGTH OF COURSE: 2 weeks full time.

_____ 1. HCO PL 7 Feb. 65 - KSW Series 1 KEEPING SCIENTOLOGY WORKING

_____ 2. HCO PL 17 June 70RB, Re-rev. 25.10.83 - KSW Series 5R TECHNICAL DEGRADES

1. * HCO PL 14 Oct 68R Auditor’s Code ______________

(NOTE: The films assigned to this course and its prerequisite courses, along with any drills called for in those films, are listed in a directive issued to Course Administrators.)

1. (To be done before the end of this course.) View any films assigned to courses which are prerequisites for this course that you have not already viewed. Any drill that is specified in a particular film is to be done after viewing that film. These films and their drills are to be filled in by the Course Administrator.

a. Film:____________________________________

1. HCOB 24 Dec 79 Resurrection of the basics of TRs ______________

b. Film:____________________________________

c. Film:____________________________________

1. Outflowing Communication ______________

d. Film:____________________________________

If a film is not scheduled for showing when you reach the indicated point on your checksheet, continue on with your study and see the film at its next scheduled showing.

Once you have viewed and been word cleared on a film, put your initials and the date in the blanks provided next to each film's title. When you do any drill called for in that film, put your initials and date in the blank provided.

a. Film:_____________________________________

1. OT TR 0 __________

b. Film:_____________________________________

c. Film:_____________________________________

d. Film:_____________________________________

1. * HCOB 23 May 71R II The two parts of Auditing ______________

_____*1. CLASSIFICATION, GRADATION AND AWARENESS CHART OF LEVELS AND CERTIFICATE - Class II Auditor section and Grade II Expanded section.

_____ 2. HCO PL 23 Oct. 80R II, Rev. 16.11.87 - CHART OF ABILITIES GAINED FOR LOWER LEVELS AND EXPANDED LOWER GRADES

_____ 3. DEMO: The Abilities Gained for Grade II.

_____ 1. Chapter: "The Vital Statistics of Scientology"

_____ 2. DEMO: Why in Scientology it is better to teach and process a person than only to process him.

_____ 3. Chapter: "Basic Principles"

_____ 4. Chapter: "The Conditions of Existence"

_____ 5. Chapter: "The Eight Dynamics"

6. DEMO: Each of the eight dynamics.

_____ 7. Chapter: "The ARC Triangle"

_____ 8. DEMO: What is the most important part of the ARC triangle, and why.

_____ 9. Chapter: "The Reason Why"

_____ 10. DEMO: Why life is a game and what the ability to play a game consists of.

_____ 11. Chapter: "The Parts of Man"

1. HCOB 7 Apr 64 Q & A ______________

_____ 12. Chapter: "Causation and Knowledge"

_____ 13. DEMO: How anxieties and upsets in human relations can come about through an imbalance of cause and effect.

_____ 14. Chapter: "Know and Not-Know"

_____ 15. Chapter: "The Goal of Scientology"

_____ 16. DEMO: What is the goal of Scientology

_____ 17. Chapter: "Scientology Processing"

_____ 18. Chapter: "Exact Processes"

1. HCOB 7 May 69 VI Summary on how to write up an Auditor’s Report etc. ______________

_____*1. HCOB 12 Nov. 59 - ACKNOWLEDGMENTS IN AUDITING

_____*2. HCOB 21 Nov. 73 - THE CURE OF Q AND A, MAN'S DEADLIEST DISEASE

_____ 3. HCOB 20 Nov. 73 I - ANTI-Q AND A DRILL

_____ 4. DRILL: Anti-Q and A TR.

1. Worksheets (W/S),

_____*5. HCOB 20 Nov. 73 II - C/S Series 89, F/N WHAT YOU ASK OR PROGRAM

_____ 6. DEMO: Why failing to F/N a reading question asked by an auditor is a version of Q&A.

_____ 7. DRILL: CR0000-4: "See the Session"

_____*8. HCOB 22 July 78 - ASSESSMENT TRs

1. Book: The Book Introducing the E-Meter, page 1-32, 40-47 (You should have an E-Meter at hand while studying this book. Do the described actions with your E-Meter as it fits to your model.) ______________

_____*9. HCOB 22 April 80R, Rev. 26.7.86 - ASSESSMENT DRILLS

10. DRILL:

_____*1. HCOB 25 May 62 - E-METER INSTANT READS

_____ 2. DEMO: What an instant read is and what it means.

_____*3. HCOB 18 Mar. 74R, Rev. 22.2.79 - EMETERS, SENSITIVITY ERRORS

_____*4. HCOB 17 May 69 - TRs AND DIRTY NEEDLES

_____ 5. DEMO: The three causes of a dirty needle and the handling for each, per HCOB 17 May 69.

_____*6. HCOB 27 May 70R, Rev. 3.12.78 - UNREADING QUESTIONS AND ITEMS

_____ 7. DEMO: Why it is that things that don't read won't run.

8. DRILL: Do the following E-Meter drills per The Book of E-Meter Drills. The Course Supervisor will issue pink sheets for any earlier E-Meter drills observed to be out.

1. * HCOB 21 Jul 78 What is a Floating Needle? ______________

_____*1. HCOB 6 Nov. 64 - STYLES OF AUDITING (Section headed LEVEL II, GUIDING-STYLE AUDITING)

_____ 2. DEMO: What is meant by "Guiding-Style Auditing"?

_____*1. HCOB 31 Dec. 59R, Rev. 21.8.87 - BLOW-OFFS

_____ 2. DEMO: The mechanism of blow-offs.

_____*3. HCOB 28 Jan. 60 - THE KEY TO ALL CASES-RESPONSIBILITY

1. HCOB 29 Jul 64 Good Indicators on Lower Levels ______________

_____ 4. DEMO: The anatomy of responsibility.

_____ 5. Tape: 620IC16 SHSBC-100 - NATURE OF WITHHOLDS

_____*6. HCOB 8 Feb. 62 - MISSED WITHHOLDS

_____ 7. DEMO: A missed withhold.

1. * HCOB 21 Jun 72 I Method 5 ______________

_____*8. HCOB 12 Feb. 62 - HOW TO CLEAR WITHHOLDS AND MISSED WITHHOLDS

_____ 9. Tape: 6202C14 SHSBC-117 - DIRECTING ATTENTION

10. DEMO:

_____ 11. Tape: 6202C20 SHSBC-113 - WHAT IS A WITHHOLD

_____ 12. CLAY DEMO: A withhold.

1. The final definition of havingness

_____*13. HCOB 22 Feb. 62 - WITHHOLDS, MISSED AND PARTIAL

_____ 14. Tape: 6204C03 SHSBC-131 - THE OVERT-MOTIVATOR SEQUENCE

_____*15. HCOB 20 May 68 - OVERT-MOTIVATOR SEQUENCE

_____ 16. CLAY DEMO: What is an overt act.

1. * HCOB 11 Aug 78 I Rudiments, Definition and Pattern ______________

_____ 17. CLAY DEMO: What is a motivator.

_____ 18. CLAY DEMO: The overt-motivator sequence.

1. ARC Break

_____ 19. HCOB 3 May 62R, Rev. 5.9.78 - ARC BREAKS, MISSED WITHHOLDS

20. DEMO: Each of the 15 manifestations of a missed withhold.

1. * HCOB 10 Dec 64 Listen Style Auditing ______________

_____ 22. Tape: 6205C22 SHSBC-151 - MISSED WITHHOLDS

_____ 23. DEMO: How Q&A drives the pc out of session.

The following attestation has to be signed item for item before the student begins to audit Grade 0 processes.

_____ 24. Tape: 6211C01 SHSBC-206 - THE MISSED MISSED WITHHOLD

If the student has any doubts or reservations to attest any of the below points he should do a retread on this area.

_____ 25. CLAY DEMO: The difference between a withhold and a missed withhold.

Only if the student has achieved these skills without any doubt he will get good results on Grade 0 Processes.

I attest that:

a) I know the study technology contained in the Student Hat and can apply it fully. ______________

b) I have applied the study technology out of the Student Hat during this course fully. ______________

_____ 28. DEMO: Demonstrate why overts give the highest gain in raising cause level.

c) I have read and understand the books ”Dianetic 55!”, ”Self Analysis”, ”Axioms and Logics” (Axioms 1-28) and ”The Problems of Work”, Chapter 6 ”Affinity, Reality and Communication” ______________

_____*29. HCOB 8 Feb. 62 - MISSED WITHHOLDS

d) I understand the E-Meter and know how to use it ______________

_____*30. HCOB 24 Aug 64 - SESSION MUST-NOTS

e) I have achieved good TRs 1-4 by drilling each TR to its EP ______________

_____ 31. DEMO: Standard auditor handling of a pc who is critical of him or her in session.

f) I can say with no reservations that I have a good understanding of the theory of ARC and the theory of communication and that I can apply them ______________

_____*32. HCOB 8 Sept. 64 - OVERTS, WHAT LIES BEHIND THEM?

g) I have mastered the steps of preparing an auditing session and can apply them ______________

_____ 33. CLAY DEMO: The cycle of an overt.

h) I understand the Scientology Auditing C/S-1 and can apply it. ______________

_____*34. HCOB 29 Sept. 65 II - THE CONTINUING OVERT ACT

i) I understand the data on clearing commands and can apply them. ______________

_____*35. HCOB 31 Jan. 70 - WITHHOLDS, OTHER PEOPLE'S

j) I am able to find and audit a havingness process. ______________

_____ 36. DEMO: The handling of a pc who gives off other people's withholds.

k) I know the model session and can use it together with simple rudiment handling. ______________

l) I understand listen style auditing and can do it ______________

m) I understand the use of prompters and am able to apply them correctly. ______________

_____ 1. Tape: 6110C04 SHSBC-62 - MORAL CODES: WHAT IS A WITHHOLD

_____ 2. DEMO: Why a Sec Check is done against a moral code.

The student must fully pass an exam on the materials of this checksheet in the Qualification Division

_____ 3. Tape: 6110C05 SHSBC-63 - SEC CHECKING: TYPES OF WITHHOLDS

Dir for Validity: _____________________________________________Date: _________________

4. DEMO:

The student now is entitled to begin with student’s auditing of Grade 0 processes (and ARC Straightwire).

BTB 15. Nov. 76 I ”Quadrupel Processes for Expanded Grades 0-IV, Part A, ARC Straightwire”

_____*5. HCOB 19 Oct. 61 - SECURITY QUESTIONS MUST BE NULLED

BTB 15 Nov. 76 II, ”Quadrupel Processes for Expanded Grades 0-IV, Part B, Grade 0 Processes”

_____ 6. DEMO: "The main danger of security checking is not probing a person's past but failing to do so thoroughly."

Nobody may or can demand that the student audits processes which are above his level of training. If a case needs processes of a higher level, students of higher levels shall be ordered to audit these actions.

_____ 7. Tape: 6110C26 SHSBC-72 - SECURITY CHECKING: AUDITING ERRORS

From the prospective auditor is expected that he drills and understands every process of grade 0 before he goes in session (see HCOB 4.7.62 COACHLESS TRAINING USE OF A DOLL)

_____ 8. DEMO: The liability of not pulling a withhold completely.

1. Audit at least one pc on each if the processes of Level 0 to the EP of each process and the attainment of the ability gained for the level or produce consistent well-done auditing hours in the style of auditing taught on Level 0 to a definite good pc result (remarkable case change). ______________

I attest that I have successfully fulfilled the auditing requirements for certification on level 0, as given above.

_____*11. HCOB 16 Nov. 61 - SEC CHECKING

Student Attest: _____________________________________________Date: _________________

_____ 12. DEMO: What the auditor should do when a pc gives a generality in response to a Confessional question.

I attest this student has successfully fulfilled the level 0 auditing requirements for certification, as given above, and has demonstrated his competence in auditing the style of this level.

_____ 13. Book: E-Meter Essentials, Chapter H

Supervisor Attest: ___________________________________________Date: _________________

_____*14. HCOB 13 Dec. 61 - VARYING SEC CHECK QUESTIONS

_____ 15. DEMO: When an auditor would vary a Sec Check question.

I have completed the requirements of this checksheet and o know and can apply the materials.

_____ 16. Tape: 6205C02 SH TVD-4A & 4B - PREPCHECKING, Parts I & II

Student Attest: _____________________________________________Date: _________________

_____ 17. Tape: 6205C03 SHSBC-142 - CRAFTSMANSHIP: FUNDAMENTALS

I have trained this student to the best of my abilities and he/she has completed the requirements of this checksheet and knows and can apply the checksheet data.

_____ 18. DEMO: How clearing withholds can improve IQ.

Supervisor Attest: ___________________________________________Date: _________________

I attest:

a) I have enrolled properly on the course.

_____ 21. DRILL: Following up on a dirty needle, on a doll. Coach answers for the doll and holds the cans, rapidly tapping his finger on the cans to simulate dirty needles or squeezing them to simulate reads. Student runs "Do birds fly?" On any dirty needle simulated by the coach, student must further question the coach on the area that produced the dirty needle. On any flunk, the coach shows the student the exact LRH reference violated. The drill is passed when the student has demonstrated he can standardly follow up on a dirty needle.

b) I have paid for the course.

_____ 22. HCOB 30 July 70 - THE TECH AND ETHICS OF CONFESSIONALS

c) I have studied and understand all the materials of this checksheet.

_____ 23. DEMO: Why a Confessional question must be taken to F/N.

d) I have done all the drills on this checksheet.

_____*24. HCOB 21 Jan. 60 - JUSTIFICATION

e) I can produce the results required in the materials of this course

_____ 25. DEMO: Justification, and how it comes about.

Student Attest: _____________________________________________Date: _________________

_____*26. HCOB 8 June 84 - FPRD Series 4, CLEARING JUSTIFICATIONS

C&A: ____________________________________________________Date: _________________

_____ 27. DEMO: Why it is important to get the preclear's justifications for an overt.

_____*28. HCOB 17 Feb. 74 - C/S Series 91, MUTUAL OUT-RUDS

I hereby attest that I have informed the student that to make his provisional certificate permanent he will have to be interned within one year.

29. DEMO:

Qual Sec or C & A: _________________________________________ Date: _________________

Certificate of Hubbard Recognized Scientologist (Class 0) (provisional) issued.

_____*30. HCOB 3 Sept. 78 - DEFINITION OF A ROCK SLAM

C & A: ___________________________________________________ Date: _________________

_____*31. HCOB 1 Nov. 74RA, Rev. 5.9.78 - ROCK SLAMS AND ROCKSLAMMERS

(Route this form to Course Admin for filing in Student’s folder.)

_____ 32. DEMO: The difference between someone who has R/Ses and a "List One R/Ser."

_____ 33. HCOB 6 June 84 I - ROCK SLAMS, MORE ABOUT

_____*34. HCOB 10 Aug. 76R, Rev. 5.9.78 - R/Ses, WHAT THEY MEAN

_____ 35. DEMO: A rock slam, using a meter with no pc or cord connected to it, as given in HCOB 10 Aug. 76R, R/Ses, WHAT THEY MEAN.

_____ 36. CLAY DEMO: "A ROCK SLAM MEANS A HIDDEN EVIL INTENTION ON THE SUBJECT OR QUESTION UNDER DISCUSSION OR AUDITING."

_____ 39. DEMO: The anatomy of a robot.

_____*40. HCOB 11 Apr. 82 - SEC CHECKING IMPLANTS

_____*41. HCOB 13 Apr. 82 - STILL NEEDLE AND CONFESSIONALS

42. DEMO:

_____ 43. HCOB 7 Jan. 85 - HCO CONFESSIONALS

_____*44. HCOB 1 Mar. 77 II - CONFESSIONAL FORMS

_____ 45. HCOB 7 May 77 - LONG DURATION SEC CHECKING

_____ 46. DEMO: When you would use Long Duration Sec Checking on a pc.

_____*47. HCOB 13 Aug. 87 - CONFESSIONALS-TYPES OF TRs

_____*50. HCOB 30 Nov. 78R, Rev. 10.11.87 - CONFESSIONAL PROCEDURE

51. DRILL: Confessional procedure on a doll. The student uses the question "Have you ever eaten an apple?" with the coach answering for the doll. Coach holds the cans and squeezes them to simulate reads. On any flunk, the coach shows the student the exact LRH reference violated. Each of the steps is done unbullbaited, then bullbaited. Each step is passed when the student has demonstrated he can do the action called for standardly.

_____ a. Clearing the Question

_____ 1. HCOB 8 Sept. 78RB, Rev. 16.11.87 - MINI LIST OF GRADE 0-IV PROCESSES (8, 9, 10)

2. DRILL:
a. Study the commands for #9 in HCOB 8 Sept. 78RB and drill it on a doll with full session setup. Coach answers for the doll and holds the cans, squeezing them to simulate reads. On any flunk, the coach shows the student the exact LRH reference violated. The drill is passed when the student can standardly run the process with the meter and keep session admin.

_____ Unbullbaited

b. Study the commands for #10 in HCOB 8 Sept. 78RB and drill it on a doll with full session setup. Coach answers for the doll and holds the cans, squeezing them to simulate reads.  On any flunk, the coach shows the student the exact LRH reference violated. The drill is passed when the student can standardly run the process with the meter and keep session admin.

_____ Unbullbaited

_____ 1. HCOB 14 Nov. 87 IV - EXPANDED GRADE II PROCESS CHECKLIST

_____ 2. HCO PL 7 Apr. 61 RC, Rev. 15.11.87 - Confessional Form 1RA, JOHANNESBURG CONFESSIONAL LIST

1. STUDENT ATTEST:

The following attest is to be signed off, point by point, before the student begins to audit Grade II processes.

If the student has any question or reservation about attesting to any of the points below, he should retread himself in that area.

Only when the student has acquired these skills without question will he or she achieve good results on Grade II processes.

I attest that:

_____ a. I know and can fully apply the study tech given in the Student Hat.

2. CONDITIONAL:

If the student has not completed Method One Word Clearing, an examination is fully passed in Qual on the materials of this checksheet.

STUDENT EXAMINER: _____________________________DATE: ____________

The student now begins student auditing of Grade II processes. Pcs are procured per HCO PL 8 June 70RC II, STUDENT AUDITING.

The student must not and cannot be required by anyone to audit processes above his training level. Where upper-level processes are necessary for a case, upper-level students should be called upon to audit the actions.

NOTE: YOU ARE NOW QUALIFIED TO BEGIN CO-AUDITING OF EXPANDED GRADE II (WITH C/S OK), AND MAY DO SO IF YOU WISH. YOU ARE NOT REQUIRED TO AUDIT THE EXPANDED GRADE IN ORDER TO COMPLETE THIS CHECKSHEET.

Ref: HCOB 8 Sept. 78RB, Rev. 16.11.87 - MINI LIST OF GRADE 0-IV PROCESSES

_____ 1. PRACTICAL: Audit #8 per HCOB 8 Sept. 78RB on a pc to completely satisfactory results by exam report and C/S attest.

_____ 2. PRACTICAL: Audit #9 per HCOB 8 Sept. 78RB on a pc to completely satisfactory results by exam report and C/S attest.

_____ 3. PRACTICAL: Audit #10 per HCOB 8 Sept. 78RB on a pc to completely satisfactory results by exam report and C/S attest.

_____ 4. CONDITIONAL: Get any errors or misunderstandings on the standard application of the materials of Level II reviewed and corrected.

5. ATTESTATIONS:

I attest that I have successfully fulfilled the auditing requirements for certification on Level II, as given above.

STUDENT ATTEST: _______________________________DATE: ____________

I attest this student has successfully fulfilled the Level II auditing requirements for certification, as given above, and has demonstrated his competence in auditing the style of this level.

SUPERVISOR ATTEST: ____________________________DATE: ____________

STUDENT C/S ATTEST: ___________________________DATE: ____________

1. STUDENT COMPLETION:

I have completed the requirements of this checksheet and I know and can apply this material.

STUDENT ATTEST: _______________________________DATE: ____________

I have trained this student to the best of my ability and he has completed the requirements of this checksheet and knows and can apply the checksheet data.

SUPERVISOR ATTEST: ____________________________DATE: ____________

2. STUDENT ATTESTATION AT C&A:

I attest: (a) I have enrolled on the course, (b) I have paid for the course, (c) I have studied and understand all the materials on the checksheet, (d) I have done all the drills on this checksheet, (e) I can produce the results required in the materials of the course.

STUDENT ATTEST: _______________________________DATE: ____________

C&A: __________________________________________DATE: ____________

3. STUDENT INFORMED RE: CERTIFICATE VALIDATION BY C&A:

I hereby attest that I have informed the student that to make his provisional certificate permanent he will have to be interned within one year.

C&A: __________________________________________DATE: ____________

4. CERTS AND AWARDS:

This graduate has been issued a certificate of HUBBARD CERTIFIED AUDITOR (Provisional).

C&A: __________________________________________DATE: ____________

(Route this form to the Course Administrator for filing in the student's folder.)

Revision assisted by

Adopted as official

LRH:CSI:RTRC: fa.rw.gm