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 EXAMINATIONS
DATE 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.

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