INTERNAL TRANSFER FORM
This form should be returned to your Adviser of Studies before 15 January
(Except Medicine and Dentistry – see guidance notes)
Late applications will be considered if places are available.
Please read accompanying guidance notes before completing the application form.
Please also complete in BLOCK CAPITALS using black ink.
SURNAME/FAMILY NAME: / FORENAMES:TITLE (Dr/MR/MISS/MS/MRS): / STUDENT NUMBER:
CORRESPONDENCE ADDRESS: / HOME ADDRESS (IF DIFFERENT):
POSTCODE: / POSTCODE:
TELEPHONE NUMBER: / TELEPHONE NUMBER:
E-MAIL: /
DATE OF BIRTH:
CURRENT DEGREE PATHWAY: / PROPOSED NEW PATHWAY:
STAGE/YEAR OF CURRENTCOURSE: / STAGE/YEAR OF
PROPOSEDNEW COURSE:
PROPOSED DATE OF
COMMENCING NEW PATHWAY: / EDUCATION AND LIBRARY BOARD:
Do you intend to complete this academic year in your current pathway? Yes No Undecided
If No, state last date of attendance on current pathway ______
Reasons for wishing to transfer: ______
______
______
PLEASE GIVE DETAILS OF RELEVANT SCHOOL LEAVING EXAMINATION RESULTS ie A AND AS LEVELS, ONC/D, HNC/D, ACCESS COURSE ETC. PLEASE ALSO LIST GCSE ENGLISH LANGUAGE AND MATHEMATICS IF YOU HAVE PASSED THESE EXAMINATIONSDATE TAKEN / SUBJECT / TITLE OF EXAM (eg ‘A’ - Level) / RESULT/
GRADE / DATE TAKEN / SUBJECT / TITLE OF EXAM (eg ‘A’ - Level) / RESULT/
GRADE
MODULES COMPLETED OR BEING TAKEN IN THE CURRENT ACADEMIC YEAR (IF APPROPRIATE)
MODULE CODE / MODULE NAME / RESULT / MODULE CODE / MODULE NAME / RESULT
Signed ______StudentDate ______
Signed ______Adviser of StudiesDate ______
Signed ______School ManagerDate ______
(CurrentSchool)
To be completed by School to which application is being made
Initial decision:
YesComments: ______
______
Conditional offerConditions: ______
______
NoReasons: ______
______
Waiting list
Selector______(Signature) Date______
Candidate notified ______(Signature) Date______
OriginalSchool notified ______(Signature) Date______
CONDITIONAL OFFER / WAITING LIST
Final decision______
______
______
Candidate notified ______(Signature) Date______
OriginalSchool notified ______(Signature) Date______
Note 1 If the candidate is accepted, the copy letter from the gaining School to the original School should generate the transfer of award form.
Note 2 This document should be retained by the gaining School and a copy sent to the original School for its records.
k:/UCAS_DOCUMENTS/Forms_Applications/Application for an Internal Transfer 2005