Goldsmiths Record of Prior Acceptance reply slip

In order for us to formally register your place with Goldsmiths we will need to create a UCAS
record for you. To do this we will need you to provide us with the following information:
Full name title! first name! surname"
#a$ma Sharif
Address
%&'( )olloway road! (ondon! #* +(,
Contact telephone num-er
.*%//'.*01&
2ate of -irth
&%31.3'&
Gender
Female
2etails of School3College where you o-tained your (evel 0 e.g. A (evels34T5C3Access"
6ualifications
5nfield County School
Full details of level 0 6ualifications su-$ect! level! grade! dates completed"
7aths 4
Chemistry C
4iology C
8ho will -e paying your fees e.g. student loan! private finance"
Student (oan
Country of -irth and nationality
Somalia! 4ritish
Country of permanent residence and date of entry to U9 if applica-le"
United 9ingdom! .'3.031''/
5thnic origin
Somali
2o you consider yourself to have a disa-ility or learning disa-ility: if so! please
provide details"
#o
2o you have a criminal conviction:
#o
I confirm that the information provided to Goldsmiths! University of (ondon! for this application is true!
complete and accurate and no information or other material information has -een omitted. I accept that
if this is not the case! UCAS and Goldsmiths! University of (ondon! shall have the right to cancel my
application and I shall have no claim against UCAS or Goldsmiths! University of (ondon in relation
thereto. I give my consent to the processing of my data -y UCAS and Goldsmiths! University of (ondon!
and any other relevant statutory -odies. I also accept that! having completed and signed the form! I do
not have the right to further choices within the UCAS scheme and will not approach any other university
or college in the UCAS scheme.
I understand I have the right to cancel this application. If I decide not to ta;e up the place at
Goldsmiths! University of (ondon I must do this -y notifying in writing as soon as possi-le.
Applicant<s signature:
#.sharif
Applicant<s name in capitals":
#A,7A S)A=IF
2ate:
1'3.>31%
?rogramme of study:
Politics