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India Standard XII Mark Form

Fields marked with * are REQUIRED.

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

* Western Student Number:	* OUAC Reference Number:

Students in India may qualify for admission based on their mid-year, predicted and mock examination results. Please complete and submit this form:

* Examination Board
School Number
If you have already received your final Standard XII Results, please provide:
Roll Number/UID
Centre Number
Admit Number/Index Number

Standard XII Results

MID-YEAR OR FINAL MARKS ARE REQUIRED FOR ADMISSION REVIEW.

If you are currently completing Standard XII, you are also encouraged to provide predicted mark and/or mock exam results using the form below.

Subject	Mid-Year Mark	Predicted Mark	Mock Exam Result	Final Mark

Standard X Results

Subject	Overall Mark	Year Completed

If you have entered Standard X results above, please upload Standard X results as a PDF file.

School Information

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

By clicking on this box, I hereby certify that all reported marks, 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!

ENTER SECURITY CODE

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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.