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Predicted International Baccalaureate (IB) Grades

FOR THOSE APPLYING FROM NON-ONTARIO SECONDARY SCHOOLS

Student Last Name or Surname:	Student First name or Given Name:

Western Student Number:	OUAC Reference Number:

Students in the IB Diploma program may qualify for admission based on their predicted/final IB results. The Admissions Office will take into consideration the predicted grades in both individual subjects and additional points for the Extended Essay and Theory of Knowledge (TOK). If you are completing the IB Diploma program, please complete and submit this form. If you are not completing the full IB Diploma, upload an official high school transcript via your To Do List on the Student Center.

Is this applicant registered in the full IB Diploma program? Yes No
Please make a selection.

Subject	Level (HIGHER or STANDARD)	Grade (1-7)	Predicted or Final?

Please indicate whether your school provides predicted Theory of Knowledge and Extended Essay Results. If 'yes' please ensure that the Diploma Points section below has been completed. Yes No
Please make a selection.

Diploma Points: (Essay and TOK)

School:
Counsellor/Principal Name:
Telephone:	Official School Email Address:

By clicking on this box, I hereby certify that all reported grades, predicted and final, are correct and complete. I understand that I may be required to provide documentation to the University to substantiate and verify this information. I have been authorized by the applicant noted above to disclose this information and he/she/they/we understand that any misrepresentation of this data may result in the cancellation of the individual's application, admission or registration status at the University at any time.
Please check the box!

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The personal information on this form is collected under the authority of The University of Western Ontario Act 1982, as amended. To view the complete Personal Information Collection Notice visit the online Academic Calendar at: http://www.westerncalendar.uwo.ca.

Predicted International Baccalaureate (IB) Grades

FOR THOSE APPLYING FROM NON-ONTARIO SECONDARY SCHOOLS

Is this applicant registered in the full IB Diploma program? Yes No Please make a selection.

Please indicate whether your school provides predicted Theory of Knowledge and Extended Essay Results. If 'yes' please ensure that the Diploma Points section below has been completed. Yes No Please make a selection.

Is this applicant registered in the full IB Diploma program? Yes No
Please make a selection.

Please indicate whether your school provides predicted Theory of Knowledge and Extended Essay Results. If 'yes' please ensure that the Diploma Points section below has been completed. Yes No
Please make a selection.