Test Answer Sheet, graded by: ____________        Pass  [___]    Fail  [___]

Applicant's name: ____________________________________________________ 


Call sign: _____________License class: ________  


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


Telephone: (day) _____________________	(night): _____________________


Signature: _____________________________ Date: _______________________

        
Pass levels:
	
Technician-	26  questions out of 35  
General-----	26 questions out of 35  
Extra--------	37 questions out of 50 
_____________________________________________________________________ 
Circle your choices below