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Predicted GCE Advanced Level Grades

Last Name or Surname:	First name or Given Name:

Western Student Number:	OUAC Reference Number:
	OUAC reference number is required.

Students completing General Certificate of Education (GCE or IGCE), may qualify for admission based on their predicted results. If you think you may qualify for admission based on your GCE results, please have your school counsellor or principal complete and submit this form.

Note: Please include all final AS-level results if AS-level exams have been completed to date.

GCE Advanced Level Results

Subject	Level (A or AS)	Predicted Grade (A-E)	Final Grade	Expected Month/Year of Completion

GCSE Ordinary Level Results

SUBJECT	O Level	Final Grade	Month/Year Taken

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

By clicking on this box, I (Counsellor/Principal) 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/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: http://www.westerncalendar.uwo.ca.