Examiners Form

HCOB 15.5.80
ATTACHMENT #2

HUBBARD COMMUNICATIONS OFFICE
Saint Hill Manor, East Grinstead, Sussex

Remimeo
Examiners Hat
Tech Services
Hat
Mimeo on 16
sub paper

HCO POLICY LETTER OF 8 MARCH 1971
(Replaces and Revises HCO PLs
of 9 May 69 and 26 Jan AD 20,
"Exam Form".)

EXAMINERS FORM

(Important Note: This form is handled exactly as per HCO PL of 26 Jan AD20 AND NO EXAMINER MAY EXAMINE UNLESS STARRATE ON THAT PL, and HCO B 5 Mar 71 (C/S Series 25) AND AN E-METER COURSE. Students and pcs can be very upset if this post's duties are not done correctly and org PC and course results ruined.)

After Session_________________ Qual Div__________(Place)

Volunteered __________________ Date_____________________

Medical_______________________ Time_____________________

PC or Pre-OT Name ______________________________________

Last Grade Attained_____________________________________

Grade, Course or Action Being Attested__________________

PC's Statement (write down exactly what PC says)

________________________________________________________

TA Position & any BD __________ PC Indicators __________

State of Needle_________________________________________

F/N Indicated to PC_____________________________________

____________________________
Signature of Examiner

ROUTE THIS FORM TO TECH SERVICES WHICH ROUTES IT INTO THE FOLDER.

WHEN ILLNESS REPORTED MAKE THIS OUT WITH A CARBON UNDER IT AND ROUTE ORIG TO T/S AND FOLDER AND CARBON TO MO OR QUAL SEC. RUSH ROUTE ANY ROLLER COASTER LATER REPORT OR SICK RPT TO FOLDER TO PREVENT C/S ERRORS.

L. RON HUBBARD
Founder