PC MG Jan 20
PC MG Jan 20
PC MG Jan 20
Pre-Calculus Mathematics
Achievement Test
Marking Guide
January 2020
Grade 12 pre-calculus mathematics achievement test.
Marking guide. January 2020
Manitoba Education
Winnipeg, Manitoba, Canada
All exemplars and images found in this resource are copyright protected and
should not be extracted, accessed, or reproduced for any purpose other than for
their intended educational use in this resource. Sincere thanks to the students who
allowed their original material to be used.
After the administration of this test, print copies of this resource will be
available for purchase from the Manitoba Learning Resource Centre.
Order online at www.manitobalrc.ca.
Disponible en français.
i
ii
General Marking Instructions
Please do not make any marks in the student test booklets. If the booklets
have marks in them, the marks will need to be removed by departmental staff prior
to sample marking should the booklet be selected.
To receive full marks, a student’s response must be complete and correct. Where
alternative answering methods are possible, the Marking Guide attempts to address
the most common solutions. For general guidelines regarding the scoring of
students’ responses, see Appendix A.
If an Answer/Scoring Sheet is marked with “0” only (e.g., student was present but
did not attempt any questions), please document this on the Irregular Test Booklet
Report.
You must contact the Assessment Consultant responsible for this project before
making any modifications to the answer keys or scoring rubrics.
Youyi Sun
Assessment Consultant
Grade 12 Pre-Calculus Mathematics
Telephone: 204-945-7590
Toll-Free: 1-800-282-8069, ext. 7590
Email: youyi.sun@gov.mb.ca
The marks allocated to questions are primarily based on the concepts and
procedures associated with the learning outcomes in the curriculum. For each
question, shade in the circle on the Answer/Scoring Sheet that represents the
marks given based on the concepts and procedures. A total of these marks will
provide the preliminary mark.
Errors that are not related to concepts or procedures are called “Communication
Errors” (see Appendix A) and will be tracked on the Answer/Scoring Sheet in a
separate section. There is a ½ mark deduction for each type of communication
error committed, regardless of the number of errors per type (i.e., committing a
second error for any type will not further affect a student’s mark), with a maximum
deduction of 5 marks from the total test mark.
Example: A student has a preliminary mark of 72. The student committed two
E1 errors (½ mark deduction), four E7 errors (½ mark deduction), and
one E8 error (½ mark deduction). Although seven communication errors
were committed in total, there is a deduction of only 1½ marks.
Shade in the circles below for a maximum total deduction of 5 marks (½ mark deduction per error).
Noircir les cercles ci-dessous pour une déduction maximale totale de 5 points (déduction de 0,5 point par erreur).
E1 ● E2 ○ E3 ○ E4 ○ E5 ○
E6 ○ E7 ● E8 ● E9 ○ E10 ○
10
2
Determine and simplify the 8th term in the binomial expansion of x − 3 .
x
Solution
7
3
2
=t C ( x) − 3 2 marks (1 mark for C ; ½ mark for each consistent factor)
8 10 7
x 10 7
( )
128
= 120 x 3 − 21
x
15 360
= − 18 1 mark for simplification (½ mark for coefficient; ½ mark for exponent)
x
3 marks
2½ out of 3
2 out of 3
+ 1 mark for consistent factors
+ 1 mark for simplification
The temperature of hot chocolate is recorded as it cools down. The data shows that the
temperature cools according to the equation:
=T 82 ( 0.87 ) t + 16
where T is the temperature of the hot chocolate, in degrees Celsius after t minutes and
In order to avoid burns, hot chocolate should not be served at a temperature higher than 71°C.
Determine, algebraically, the amount of time it will take the hot chocolate to reach this
temperature.
Solution
=71 82 ( 0.87 ) t + 16
55 = 82 ( 0.87 ) t
55
= 0.87 t
82
55
log = t log ( 0.87 ) ½ mark for applying logarithms
82 1 mark for power law
55
log
t= 82
log ( 0.87 )
t = 2.867 874
t = 2.868 minutes ½ mark for evaluating quotient of logarithms
2 marks
1 out of 2
+ ½ mark for applying logarithms
+ ½ mark for evaluating quotient of logarithms
Exemplar 2
2 out of 2
award full marks
E6 (rounding too early)
Pre-Calculus Mathematics: Marking Guide (January 2020) 9
Question 3 T5
3sin 2θ + 6sin θ + 2 =0
Solution
3 marks
2½ out of 3
+ ½ mark for solving for sin θ
+ 1 mark for indicating no solution
+ 1 mark (½ mark for each consistent value)
Exemplar 2
2½ out of 3
+ ½ mark for substitution into quadratic formula
+ ½ mark for solving for sin θ
+ ½ mark for consistent value of θ
+ 1 mark for indicating no solution
Pre-Calculus Mathematics: Marking Guide (January 2020) 11
Question 4 P3
A committee of 4 people is to be selected from 6 high school students and 5 middle years
students.
Determine the number of possible committees if the committee must have at least 3 high school
students.
Solution
3 marks
Note:
C does not need to be shown.
5 0
2 out of 3
award full marks
– 1 mark for concept error (addition within Case 1)
Exemplar 2
2 out of 3
award full marks
– 1 mark for concept error (using permutations)
Solution
y
f ( x)
1 mark for absolute value
1 mark for vertical reflection
2 marks
1
x
1
1 out of 2
+ 1 mark for absolute value
E9 (coordinate points labelled incorrectly)
Exemplar 2
f ( x)
1
x
1
1 out of 2
+ 1 mark for vertical reflection
Pre-Calculus Mathematics: Marking Guide (January 2020) 15
Question 6 R2, R3
x
=
Describe the transformations used to obtain the graph of the function y 4 f − 3 from the
2
graph of y = f ( x ) .
Solution
3 marks
Note:
Deduct a maximum of 1 mark for concept error of incorrect order of vertical
transformations.
3 out of 3
Exemplar 2
1 out of 3
+ 1 mark for vertical stretch
+ 1 mark for vertical translation
– 1 mark for concept error of incorrect order of vertical transformations
Exemplar 3
3 out of 3
Solution
( 2
log 48 = log 4 3 )
1 mark for power law
= 2log 4 + log 3
1 mark for product law
= 2m + n
2 marks
1 out of 2
+ 1 mark for product law
Exemplar 2
2 out of 2
award full marks
E1 (final answer not stated)
Exemplar 3
1½ out of 2
award full marks
– ½ mark for procedural error (incorrect substitution)
Solution
2 marks
Domain:
Range:
2 out of 2
award full marks
E7 (notation error)
E8 (bracket error made when stating domain and range; range written in incorrect order)
Exemplar 2
Domain:
Range:
1 out of 2
+ 1 mark for domain
Solution
or
As the graph of y = tan x approaches the vertical asymptotes, the function value approaches
positive and negative infinity.
1 out of 1
Exemplar 2
1 out of 1
Exemplar 3
½ out of 1
award full marks
– ½ mark for terminology error in explanation
Solution
Method 1
Left-Hand Side Right-Hand Side
2
1 sin θ csc 2θ − 1
−
cos θ cos θ
sin θ sin θ
( )
cos θ
2
1 − sin θ
cosθ
2
sin θ
cos θ
cos 2θ
2
sin θ
2
cot θ
csc 2θ − 1
3 marks
Method 2
(
secθ 1 − sin 2θ ) csc 2θ − 1
sin θ
( sin θ )
cos θ
1
cos θ
( 2
cos θ )
2
sin θ
cos θ
2
cos θ
cos θ
sin 2θ
cos θ
cot 2θ
csc 2θ − 1
3 marks
2 out of 3
+ 1 mark for correct substitution of appropriate identities
+ 1 mark for algebraic strategies
2 out of 3
+ 1 mark for correct substitution of appropriate identities
+ 1 mark for logical process to prove the identity
3 out of 3
award full marks
E3 (variable omitted in an identity)
form.
Solution
3 1 0 −7 −6 1 mark for synthetic division (or equivalent strategy)
3 9 6
1 3 2 0
(
p( x ) = ( x − 3) x 2 + 3 x + 2 ) ½ mark for factor of ( x − 3)
2 marks
p( x ) =
1 out of 2
p( x ) =
1½ out of 2
+ 1 mark for synthetic division
+ ½ mark for factor of ( x − 3)
Exemplar 3
p( x ) =
1 out of 2
+ 1 mark for synthetic division
+ ½ mark for factor of ( x − 3)
– ½ mark for procedural error in line 1 (missing coefficient of zero)
Pre-Calculus Mathematics: Marking Guide (January 2020) 31
Question 12 P2
Solve, algebraically.
P =6
n +1 2
Solution
( n + 1)! =6 ½ mark for substitution
( n + 1 − 2 )!
( n + 1)! = 6
( n − 1)!
( n + 1)( n ) ( n − 1)!
=6 1 mark for factorial expansion
( n − 1)! ½ mark for simplification of factorials
n2 + n =6
n2 + n − 6 =0
( n + 3)( n − 2 ) =
0
3 marks
2½ out of 3
+ ½ mark for substitution
+ 1 mark for factorial expansion
+ ½ mark for simplification of factorials
+ ½ mark for the permissible value of n
E4 (missing brackets but still implied in lines 1 to 3)
Exemplar 2
2½ out of 3
+ 1 mark for factorial expansion
+ ½ mark for simplification of factorials
+ ½ mark for permissible value of n
+ ½ mark for showing the rejection of the extraneous root
E2 (changing an equation to an expression in line 2)
E7 (notation error in line 2)
Pre-Calculus Mathematics: Marking Guide (January 2020) 33
Exemplar 3
2 out of 3
+ ½ mark for substitution
+ 1 mark for factorial expansion
+ ½ mark for simplification of factorials
E7 (notation error in line 3)
Solution
2 marks
1½ out of 2
award full marks
– ½ mark for procedural error in line 2
Exemplar 2
2 out of 2
award full marks
E7 (notation error)
Exemplar 3
1 out of 2
+ 1 mark for quotient law
Pre-Calculus Mathematics: Marking Guide (January 2020) 37
Question 14 R12
Solution
y
3 marks
2½ out of 3
award full marks
– ½ mark for incorrect shape of graph at x = 2
Exemplar 2
2 out of 3
award full marks
– 1 mark for concept error (multiplicity of 3 at x = −3 )
1½ out of 3
+ 1 mark for multiplicity of 2 at x = −2
+ ½ mark for end behaviour
Exemplar 4
1½ out of 3
+ 1 mark for x-intercepts
+ ½ mark for y-intercept
E9 (scale values on x-axis not indicated)
Learning
Question Answer
Outcome
15 B R1
16 D R6
17 A R14
18 C R7
19 A R11
20 B P2
21 B T3
22 C T1
a) h( x ) =
2
−2 x − 35
b) h( x ) =−2 x − 19
c) h( x ) =
2
−2 x − 19 x − 35
d) h( x ) =−2 x + 2
Question 16 R6
The function y = f ( x ) has a domain of [ 2,5] and a range of [ −6,3]. Identify the range of the
−1
function y = f ( x ).
a) [ −6, 3]
b) [ −5, 2 ]
c) [ −3, 6 ]
d) [ 2, 5]
Question 17 R14
Identify the function that has a graph with a point of discontinuity (hole) at x = −3.
x+3
a) y =
x2 − 9
x −3
b) y =
x2 − 9
x2 − 9
c) y =
x −3
x2 + 9
d) y =
x+3
a) 0
b) log e
c) 1
d) e
Question 19 R11
When the polynomial function, p( x ) , is divided by ( x − 4 ) the remainder is 17. Identify which
statement is true.
a) p( 4 ) = 17
b) p( −4 ) =
17
c) p( 4 ) = 0
d) p( −4 ) =
0
Question 20 P2
1
b)
( n − 4 )( n − 5)
c) ( n − 6 )( n − 5 )
1
d)
( n − 6 )( n − 5)
44 Pre-Calculus Mathematics: Marking Guide (January 2020)
Question 21 T3
4
Identify the quadrant in which θ terminates if secθ = − and sin θ > 0.
3
a) I
b) II
c) III
d) IV
Question 22 T1
π
Identify the expression that represents all angles that are coterminal with .
3
π
a) + πk , k ∈
3
π
b) + πk , k ∈
3
π
c) + 2πk , k ∈
3
π
d) + 2πk , k ∈
3
1
Given f ( =
x) x − 3, state the coordinates of an invariant (unchanged) point when sketching the
2
graph of y = f ( x ) .
Solution
1
x −3 =0
2
1
x=3
2
x=6
( 6,0 ) 1 mark
or
1
x −3 = 1
2
1
x=4
2
x =8
(8,1)
0 out of 1
award full marks
– 1 mark for concept error (not relating f ( x ) to its radical)
Exemplar 2
½ out of 1
award full marks
– ½ mark for procedural error in line 3
1 out of 1
award full marks
E7 (notation error)
Exemplar 4
½ out of 1
award full mark
– ½ mark for procedural error (incorrect slope of f ( x ) )
Solve, algebraically.
x
1
125 3 x+ 4 =
5
Solution
(5 ) 3 3x+4
( )
= 5
−1 x
1 mark for changing to a common base (½ mark for each side)
9 +12 −
5 x =5 x ½ mark for exponent law
9 x + 12 =
−x ½ mark for equating exponents
10 x = −12
2 marks
12
x= −
10
or
6
x= −
5
1 out of 2
+ ½ mark for exponent law
+ ½ mark for equating exponents
Exemplar 2
1½ out of 2
+ 1 mark for equivalent strategy
+ ½ mark for power law
E1 (final answer not stated)
1½ out of 2
award full marks
– ½ mark for arithmetic error in line 4
Exemplar 4
0 out of 2
2 2
Given sin θ = − and cos θ = − , justify that the value of tan ( 2θ ) is undefined.
2 2
Solution
Method 1
2 tan θ
tan ( 2θ ) =
1 − tan 2θ
2 (1) 1 mark for value of tan θ
=
1 −1
2
=
0
2 marks
Method 2
tan θ = 1
5π
θ= 1 mark for value of θ
4
5π
tan ( 2θ ) = tan 2
4
5π
= tan
2
2 marks
1½ out of 2
award full marks
– ½ mark for procedural error in line 1
Exemplar 2
1 out of 2
+ 1 mark for value of tan θ
Pre-Calculus Mathematics: Marking Guide (January 2020) 55
Exemplar 3
1½ out of 2
award full marks
– ½ mark for procedural error in line 2 (incorrect value of θ )
Solution
y
3 marks
(1,0 )
x
( 3, −2 )
2 out of 3
award full marks
– 1 mark for concept error (exponential graph)
E10 (asymptote omitted but still implied)
Exemplar 2
2 out of 3
+ 1 mark for vertical reflection
+ 1 mark for vertical stretch
2 out of 3
+ 1 mark for asymptotic behaviour approaching x = 0
+ 1 mark for vertical reflection
Evaluate.
π
cos π sin −
6
Solution
1
cos π − π
2 1 mark for sin − (½ mark for quadrant; ½ mark for value)
6
π
cos −
2
1 mark for consistent value
0
2 marks
1 out of 2
π
+ 1 mark for sin −
6
Exemplar 2
1½ out of 2
π
+ ½ mark for the value of sin −
6
+ 1 mark for consistent value
1½ out of 2
award full marks
– ½ mark for procedural error in line 1
Exemplar 4
0 out of 2
Solution
a) y
1
x
1
1 mark
b) Since the domain of y = f ( x ) does not have any restrictions, then the domain of the
composition does not have any restrictions.
1 mark
0 out of 1
b)
1 out of 1
½ out of 1
award full marks
– ½ mark for procedural error (incorrect slope)
b)
½ out of 1
award full marks
– ½ mark for lack of clarity in explanation
1 out of 1
b)
½ out of 1
award full marks
– ½ mark for lack of clarity in explanation
3x − 5
a) Sketch the graph of f ( x ) = .
2x + 4
Solution
1 1
x
3 marks
3
b) Range: y ∈ y ≠ 1 mark for range consistent with graph
2
1 mark
3 out of 3
award full marks
E9 (coordinate point labelled incorrectly)
b)
Range:
0 out of 1
2 out of 3
+ 1 mark for asymptotic behaviour approaching x = −2
+ ½ mark for graph right of x = −2
+ ½ mark for graph left of x = −2
b)
Range:
1 out of 1
1½ out of 3
+ 1 mark for asymptotic behaviour approaching x = −2
+ ½ mark for graph right of x = −2
b)
Range:
0 out of 1
Determine, algebraically, the equation of p( x ) that satisfies all of the following conditions:
Solution
½ mark for factors of p( x )
p( x ) = a ( x + 1)( x + 2 )( x − 3)
2
½ mark for multiplicity of 2 at x = 3
24 = a ( 2 + 1)( 2 + 2 )( 2 − 3)
2
½ mark for substitution of p( 2 ) = 24
24 = 12a
a=2 ½ mark for consistent value of a
p( x ) = 2 ( x + 1)( x + 2 )( x − 3)
2
2 marks
p( x ) =
1 out of 2
p( x ) =
1½ out of 2
cos θ + cot θ 2π
Verify, by substitution, that the equation = 1 + sin θ is true for θ = .
cot θ 3
Solution
− 3−2 2+ 3
2 3 2
1
−
3
3+2 1 mark for simplification
2 (½ mark for LHS; ½ mark for RHS)
− 3−2
−2 3 marks
− ( 3+2 )
−2
3+2
2
Note:
2π
Deduct a maximum of 1 mark if student proves identity without substitution of θ = .
3
2 out of 3
+ ½ mark for substitution
2π
+ ½ mark for exact value of sin
3
+ 1 mark for simplification
2½ out of 3
+ ½ mark for substitution
+ 1½ mark for exact values
+ ½ mark for simplification of RHS
3 x − 15
Jyugo was asked to state the equation of the vertical asymptote(s) on the graph of f ( x ) = .
x 2 − 5x
His solution:
Solution
His solution at x = 5 is the x-value of a point of discontinuity (hole), not a vertical asymptote.
1 mark
1 out of 1
Exemplar 2
0 out of 1
1
=
Sketch the graph of y sin x − 1 over the interval [ −2π, 2π ].
2
Solution
y
1 mark for shape of y = sin x
1 mark for period
1 mark for vertical translation
3 marks
x
−2π − π π 2π
−1
−2
3 out of 3
award full marks
E8 (answer outside the given domain)
Exemplar 2
3 out of 3
award full marks
E9 (scale values on y-axis not indicated)
2 out of 3
+ 1 mark for period
+ 1 mark for vertical translation
Exemplar 4
1½ out of 3
+ 1 mark for shape of y = sin x
+ 1 mark for vertical translation
– ½ mark for procedural error (incomplete domain of graph)
Solution
y
1
x
1
3 out of 4
+ 1 mark for shape of a radical function
+ 1 mark for horizontal reflection
+ 1 mark for horizontal compression
1
x
1
3 out of 4
+ 1 mark for shape of radical function
+ 1 mark for horizontal reflection
+ 1 mark for horizontal translation
1
x
1
1 out of 4
+ 1 mark for shape of a radical function
110°
π
9
Q R
Solution
π 11π
(110 ) = 1 mark for conversion
180 18
π 11π
∠ R =π − +
9 18
18π 2π 11π
∠ R= − +
18 18 18
5π
∠R = 1 mark for angle R
18
2 marks
2 out of 2
award full marks
E5 (answer stated in degrees instead of radians)
Exemplar 2
2 out of 2
award full marks
E7 (transcription error in line 1)
Given f ( =
x) x − 4, state the equation of the resulting function, g ( x ) , after a reflection over
the x-axis.
Solution
g( x ) =
− x−4 1 mark for vertical reflection
1 mark
g( x ) =
0 out of 1
Exemplar 2
g( x ) =
1 out of 1
29π
a) Determine the coterminal angle of over the interval [ 0, 2π ].
12
29π
b) Determine the exact value of sin .
12
Solution
5π
a) 1 mark
12
b)
5π π π
sin = sin +
1 mark for substitution into correct identity
12 6 4
π π π π
= sin cos + cos sin
6 4 6 4
1 2 3 2
= + 2 marks (½ mark for each exact value)
2 2 2
2
2 6 3 marks
= +
4 4
2+ 6
=
4
or
1+ 3
=
2 2
Note:
Other combinations are possible.
0 out of 1
b)
2½ out of 3
award full marks
– ½ mark for procedural error (incorrect combination)
Exemplar 2
a)
1 out of 1
b)
2 out of 3
award full marks
– 1 mark for concept error
1 out of 1
b)
1 out of 3
5π
+ ½ mark for exact value of sin
3
3π
+ ½ mark for exact value of sin
4
1 1
x x
1 1
g( x )
Solution
y
h( x )
2 marks
1
x
1
1
x
1
1 out of 2
+ 1 mark for restricted domain
Exemplar 2
1
x
1
½ out of 2
+ 1 mark for operation of subtraction
– ½ mark for procedural error (1 incorrect point)
1
x
1
2 out of 2
award full marks
E9 (arrowhead omitted)
• an amplitude of 3
• a period of 6
• a minimum value of −5
Solution
=y A sin ( Bx ) + D
1 mark for value of A
π
=y 3sin x − 2 1 mark for value of B
3 1 mark for value of D
or
=y A cos ( Bx ) + D 3 marks
π
=y 3cos x − 2
3
Note:
Other equations are possible.
1½ out of 3
+ 1 mark for value of A
+ 1 mark for value of B
– ½ mark for procedural error (not written as an equation)
Exemplar 2
1 out of 3
+ 1 mark for value of A
Exemplar 3
2½ out of 3
award full marks
– ½ mark for procedural error (omitted “x”)
Given the graph of y = f ( x ) , sketch the graph after a reflection over the line y = x.
Solution
y
f ( x)
1 mark for reflection over the line y = x
1 mark
1
1
x
f ( x)
1
x
0 out of 1
Exemplar 2
f ( x)
1
x
1
1 out of 1
award full marks
E9 (arrowhead omitted)
f ( x)
1
x
½ out of 1
award full marks
– ½ mark for procedural error (connected points in incorrect order)
Solution
3 ( −27 ) + 5 ( 9 ) − 13 ( −3) − 3
0
or
−3 3 5 −13 −3
−9 12 3
1 mark for synthetic division
3 −4 −1 0 (or any equivalent strategy)
1 mark
½ out of 1
award full marks
– ½ mark for arithmetic error in line 3
E7 (transcription error in line 1)
b)
1 out of 1
Exemplar 2
a)
1 out of 1
b)
½ out of 1
award full marks
– ½ mark for lack of clarity in explanation
State the range, the y-intercept, and the equation of the asymptote of the exponential function,
( x ) 3 x − + 2.
f=
1
Solution
7
y -intercept: 1 mark for y-intercept
3
Equation of the asymptote: y = 2 1 mark for equation of the asymptote
3 marks
Range:______________________________
y -intercept:__________________________
2 out of 3
+ 1 mark for range
+ 1 mark for y-intercept
E8 (bracket error made when stating range)
=
The graph of y 2 cos ( 3 x ) − 1 below can be used to solve the equation
= 0 2cos ( 3 x ) − 1 over
the interval [ 0, 2π]. Indicate on the graph where to find at least one solution to the equation
=0 2cos ( 3 x ) − 1.
y
Solution
1 mark
Note:
Students do not need to show all six arrows.
Errors that are conceptually related to the learning outcomes associated with the question
will result in a 1 mark deduction.
Each time a student makes one of the following errors, a ½ mark deduction will apply:
arithmetic error
procedural error
terminology error in explanation
lack of clarity in explanation, description, or justification
incorrect shape of graph (only when marks are not allocated for shape)
Communication Errors
The following errors, which are not conceptually related to the learning outcomes associated
with the question, may result in a ½ mark deduction and will be tracked on the
Answer/Scoring Sheet.
answer given as a complex fraction
E1 final answer not stated
final answer impossible solution(s) not rejected in final answer and/or in step
leading to final answer
E2 changing an equation to an expression or vice versa
equation/expression equating the two sides when proving an identity
E4 2 2
“ sin x ” written instead of “ sin x ”
brackets missing brackets but still implied
E7 notation error
notation/transcription transcription error
During the marking of provincial tests, irregularities are occasionally encountered in test
booklets. The following list provides examples of irregularities for which an Irregular Test
Booklet Report should be completed and sent to the department:
Student comments or responses indicating that the student may be at personal risk of being
harmed or of harming others are personal safety issues. This type of student response
requires an immediate and appropriate follow-up at the school level. In this case, please
ensure the department is made aware that follow-up has taken place by completing an
Irregular Test Booklet Report.
Except in the case of cheating or plagiarism where the result is a provincial test mark of
0%, it is the responsibility of the division or the school to determine how they will proceed
with irregularities. Once an irregularity has been confirmed, the marker prepares an
Irregular Test Booklet Report documenting the situation, the people contacted, and the
follow-up. The original copy of this report is to be retained by the local jurisdiction and a
copy is to be sent to the department along with the test materials.
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Decision: _________________________________________________________
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Consultant: ________________________________________________
Date: _____________________________________________________