Predicted Caribbean Advanced Proficiency Examination (CAPE) Grades

Student Last Name or Surname:

Student First name or Given Name:

Western Student Number:

OUAC Reference Number:

Students following the Caribbean Advanced Proficiency Examinations (CAPE) Diploma may qualify for admission based on their predicted results. If you think you may qualify for admission based on your CAPE results, please complete and submit this form.

Note: Final year 1 CAPE results and predicted or final year 2 CAPE results are necessary for evaluation.

Caribbean Advanced Proficiency Examinations (CAPE)

Subject	Level (Unit 1 or 2)	Predicted Grade ONE - SEVEN	Final Grade	Expected Month/Year of Completion

Caribbean Secondary Education Certificate (CSEC) results

CSEC SUBJECT	Final Grade	Month/Year Taken

School Information

School:

Date:

Counsellor/Principal Name:

Telephone:

Fax:

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.

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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: https://www.westerncalendar.uwo.ca.