COMMERCE INSURANCE, 211 MAIN STREET, WEBSTER, MASSACHUSETTS 01570 (508) 943·9000
GOOD STUDENT DISCOUNT FORM
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STUDENT INFORMATION
StudentName: --------------------------------------
School Class: Freshman ___ Sophomore ____ Junior __ Senior __
SCHOOL INFORMATION
School Name and Address:
ACADEMIC CERTIFICATION (To be Completed by School Official)
For the academic period immediately preceding this certification, the student noted above has met one of the following requirements:
__ Is in the upper 20% of his or her class scholastically; OR
__ Maintains a "B" average or higher, or its equivalent, or if the letter grading system cannot be average then no grade is below a "B"; OR
__ Maintains a numerical grade point average or "3.0", in a system assigning numerical grade points of 4.0, 3.0, 2.0, and 1.0; OR
__ Was included on the "Dean's List", "Honor Roll", or comparable list indicating scholastic achievement.
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ACADEMIC CERTIFICATION - HOME SCHOOLED STUDENTS
For Home Schooled students, two certification options are available:
__ Attach a standardized form certified by a 3rd party organization showing evidence that one of the above listed qualifications has been satisfied; OR
___ Attach evidence of the student scoring in the upper 20% on an annual national standardized exam.