Assessment Program Application

School Name

Teacher or other contact person for assessment program

Scheduling Information

Expected instructional schedule:

Expected assessment schedule (include approximate dates and number of students expected to complete assessments):

Cash rebates are paid only for assessments completed between May 1 and December 31, 2019, unless a different ending date has been agreed to by both the purchaser and Principles & Choices (P&C). Please check one of the following:

We expect to complete all P&C assessments eligible for rebates by December 31, 2019.We request a later date for completing P&C assessments that are eligible for rebates. Please contact me for scheduling details.

Purchase Information

Will you be purchasing P&C textbooks directly from us?Yes! Please include my 15% discount!No

Will your students be purchasing P&C textbooks directly from us?Yes, please send me a discount code to share with students.No

If you answered “NO" to BOTH questions, please complete the shaded section below (required):

Complete this section for past purchases or planned purchases from a distributor:

Do your students use ebooks or print books?	Purchased from:
eBooks	---iTunesTextbooks.comEdTech
Print books	---Principles & ChoiceseCampusFollettMBSOtherNot sure

Approximate date of purchase and quantity of each book:

Principles & Choices Book	Date of purchase	Quantity
Book 1: Identity and Values
Book 2: Truth and Reason
Book 3: Ethics and Justice

Please note:

1. In cases where the stated quantity purchased from distributors substantially differs from the quantity reported to Principles & Choices by these distributors, Principles & Choices reserves the right to request proof of purchase from the school before honoring the incentive agreement.

2. Schools and/or students who purchase used books and/or new books from third-party sellers other than Follett or MBS may be ineligible for assessment program rebates.

Certification

By submitting this form, I certify that I am authorized to enter into a binding agreement on behalf of my school, namely:

My school agrees to participate in the Principles & Choices Assessment Program, according to all the terms and conditions explained on the “15+15 Cashback Incentive Program” Web page, in exchange for a 15% percent discount on the purchase price of textbooks and/or a cash rebate. I understand that failure to complete the assessment program as described in the instruction document will result in cancellation of the incentive offer: no cash rebates will be paid and my school will be required to refund to Principles & Choices any discounts received.