Test Answer Sheet					Grade ________________
							Pass  [_]	Fail  [_]
Circle Element >>>> 2  3A  3B  4A  4B			Test # _________________
									     
Student's name: _________________________________ 

Call sign: _____________	License class: ____________	Birth date:__________

Address (Street/City/State/Zip):________________________________________________

Telephone: (day) ___________________________	(night) ____________________

Signature: ________________________________________ Date ____________________
        
Pass levels:
Novice    	26/35     
Technician	22/30     
General   	19/25  
Advanced  	37/50   
Extra     	30/40