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MACCLESFIELD TUTORIAL COLLEGE

Examination Application Form: page 1 of 2


PLEASE COMPLETE ONE APPLICATION FORM FOR EACH EXAMINATION SERIES, ENSURING THAT YOU HAVE FILLED IN ALL DETAILS OR WRITTEN N/A IN SPACES WHICH DO NOT APPLY TO YOU. HAVING TO RETURNING INCOMPLETE FORMS TO YOU WILL DELAY THE PROCESSING OF YOUR APPLICATION, POSSIBLY LEADING TO LATE ENTRY FEES.

PLEASE WRITE IN BLOCK CAPITALS.

Refer to the Notes for Guidance. If you are unsure about an answer, please telephone for clarification. 1. Exam series: (Choose from January : March : May/June : November) 2. Full name, as shown on your birth (or marriage) certificate or passport: Title (Mr/Mrs/Miss) ____ First name(s) ___________________ Surname _______________________ 3. Gender: Male / Female: Date of Birth___/___/___ 4. Email address _________________________ 5. Address __________________________________________________________________________ _________________________________________________ Postcode _______________ 6. Home Telephone number ________________________ Mobile number _______________________ 7. Have you taken exams at Macclesfield Tutorial College before? Yes / No. If yes: dates __________ Month _________ 201__

8. Unique Candidate Identifier (UCI) _______________________________________________________ 9. If following a distance learning course: Organisation_________________ Telephone ______________ 10. Names of centres, with centre number if known, where you have taken exams before, . _________________________________________________________________________________ 11. Any special requirements (extra time/access) _____________________________________________
SUBJECT 1 SUBJECT 2 SUBJECT 3 Office use only

12 13 14

Subject
Title / Name

C.Number

Level:
GCSE/ IGCSE/ GCE AS / GCE A2

Exam Board
AQA / OCR / Edexcel / WJEC

Recd

15a Are you entering a coursework


option / ISA / controlled test?

Admin Fee

15b Is coursework entered through


MTC or another centre?

PCCIF

16 17

Who is marking your coursework?

Titles and codes


of all modules (including coursework option)

Board

18 19 20 21

GCSE / IGCSE Tier


(Higher / Foundation)

T/Table

Is this subject available to private candidates?

Photo ID

Subject award (cash-in)


code if required Are you expecting pre-release material? When?

SoE sent

PLEASE COMPLETE FULLY AND RETURN THESE 2 PAGES TO MACCLESFIELD TUTORIAL COLLEGE

MACCLESFIELD TUTORIAL COLLEGE


Examination Application Form: page 2 of 2 NAME OF CANDIDATE ___________________________________________________________

1. IDENTIFICATION
Please include with this application: 1. two passport-style/size photographs (no photocopies) of yourself. The reverse of the photographs must by signed and dated by a teacher or other professional person with the words This is a true likeness of (your name). 2. a brief, dated letter from a referee i.e. a teacher or other professional person, showing their name, address and telephone number, which confirms your identity. These must accompany your application form. Please note that the examination boards also require you to bring photographic identification - passport or photo driving licence - with you for each examination. Please give details of your referee who has provided confirmation of your identity: Name of referee ____________________________________________ Email __________________________________________________
For office use only

Address __________________________________________________ ____________________________ Postcode _____________ Home telephone number ________________ Mobile _______________

2. DECLARATION
In submitting this application for examination entry I agree to accept the terms and conditions of Macclesfield Tutorial College. Signed (Candidate) ____________________________________ Date ____________________ For candidates under 18 years of age, the section below should also be completed by a responsible adult. In submitting this application for examination entry I agree to accept the terms and conditions of Macclesfield Tutorial College. Name Email _________________________________________ Parent / Carer / Guardian (please delete) _______________________________________________________________________

Address _______________________________________________________________________ _____________________________________ Postcode _________________________ Home telephone number ________________________ Mobile telephone __________________ Signed _____________________________________ Date ___________________________

PLEASE COMPLETE AND RETURN THESE 2 PAGES TO MACCLESFIELD TUTORIAL COLLEGE 20 CUMBERLAND STREET, MACCLESFIELD, CHESHIRE, SK10 1DD Please complete all sections / boxes; write not applicable (N/A) where a section does not apply to you. Incomplete forms will be returned to you, which will result in a delay in processing your entry. (KEEP A COPY OF THIS APPLICATION FORM FOR YOUR RECORDS)

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