University of Western Ontario
Department of Computer Science

Computer Science 211b Assignment Submission Form

This sheet must be submitted with your assignment. Failure to complete, sign and submit this form will result in a mark of 0 for the assignment.  Fill in the following information:

Assignment #  
Student Surname  
Given Name(s)  
Student Number  
Computer Username  
# of Late Coupons Used  

By submitting this form and signing below, I declare that:


Signature: ________________________________________________________________

Date: __________________________