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First name

Surname

Age

Address

Term-time address (if different, otherwise write 'N/A')

Your Email address

Your telephone/mobile number. Include international dialling code if outside the UK

We recommend installing the new Google Duo app for your iPhone or Android phone. Otherwise we will call the standard way.

What is your Nationality? BritishEUOther

If non-British or non-EU, what is your Citizenship?

Are you fluent in English? ---YesNo

Are you fluent in German? ---YesNo

Do you have at least 6 GCSEs at grade A* - C, including Maths AND English? ---YesNo

Please select the status of your A-Levels I have completed my A-Levels and have my resultsI am completing my A-Levels and awaiting my results

Do you have (or will you have in the August 2017), 3 A-Levels including Chemistry AND Biology? ---YesNo

Have you re-taken any of your A-Levels? (This question is not asking about re-sitting modules, rather it is asking if you have re-taken A-Levels beyond the standard 2 years for AS/A2)---YesNo

What are your A-Level grades? (Insert predicted grades if currently studying A-Levels) ---Below EEEBetween EEE and CCD (inclusive)Between CCC and BBC (inclusive)Between BBB and ABB (Inclusive)AAB or better

Where did you hear about us? (required) ---FacebookGAMSAT 2015 (NEC)GAMSAT 2016 (Olympia)The Student Room forum advertThe Student Room email 2015The Student Room email 12th Aug 2016The Student Room email 19th Aug 2016Web search (Google etc)Google Advert (Adwords)CollegeTwitterUniversityWord of mouthYoutubeOther

Please indicate your availability for a call AnytimeEvenings and weekends onlyDaytime, not eveningsWeekends only

We will look at your data and will get back to you a list of universities that are still taking applications for Feb and Sept/Oct 2017 entry AND have entrance requirements suitable to your grades. We can also discuss other options suitable for you.