Your HGS Email Address (if issued)

Your email address is of the format username@hgs.k12.va.us

STUDENT MATERIALS RECEIPT: Terms & Conditions

I, whose full name appears on this form, in consideration of a 16 GB USB drive, HGS lanyard, HGS pen, headset, HGS tote bag, and HGS 2022-2023 academic year planning book, receipt of which is hereby acknowledged, am solely responsible for and will make use of during my Governor's School term(s) and will return to the A. Linwood Holton Governor's School office if I should reconsider taking the above course(s) or should drop the above Governor's School course(s) prior to successful completion.

I understand that at the successful completion of all Governor's School class(s) taken during the academic year, I will immediately thereafter surrender the headset to my high school's Governor's School representative (e.g., Guidance Counselor) where it will be retained for future use. Furthermore, having successfully completed the course(s), I shall keep the flash drive with lanyard, tote bag, planning book, and pen.

This Student Material Receipt shall be effective as to the transfer of property listed above as of this date.