This document contains a record of prior acceptance for a student applying to university. It includes personal information like name, date of birth, address, nationality, and disability status. It also includes details about the chosen course of study like the course code, campus, and intended start date. By signing the declaration, the student confirms the accuracy of the information and accepts the terms of not pursuing other university choices if accepted to the program listed in the application.

1. Record of prior acceptance
Student information
(*Mandatory information)
Title*
First name*
Make sure your name is as it appears on any
official documents, such as your passport, birth
certificate or driving licence.
Lily
Last name*
If you don't have a last name, add your first
name here again.
Ajaib
Gender*
Please choose from male or female, selecting
the gender you most identify with at this time.
Female
Date of birth* 23/05/2005
Address line 1* 3 Cranbrook Close, Wheldrake
Address line 2 York
Address line 3
Address line 4
Postcode (UK only)
Non-UK postcodes should be entered on the
last line of the address
YO19 6BY
Country of address* England
Email address* lilyajaib@gmail.com
Telephone number
Fee payer*
This is who will fund your studies. Circle or
highlight the option that applies to you.
Private finance | SLC,SAAS,NIBd,EU,Chl,IoM | Research Council | DH/Regional
Health | UK Govt intl award | Training Agency | Other UK govt award |
International agency; UK industry/commerce | Other source | Not Known
Area of permanent residence*
This is the area in which you normally live.
If your permanent home is in the UK this is the
county you live in. If you live outside the UK,
tell us the country you live in.
UK
Residential category*
Circle or highlight the option that applies to
you.
EEA or Swiss national | Child of a Turkish Worker | Refugee | Humanitarian
Protection or similar | Settled in the UK | Other | UK Citizen – England | UK
Citizen – Scotland | UK Citizen – Wales UK Citizen - Northern Ireland | British
Citizen - Channel Islands and Isle of Man | British Citizen - British Overseas
Territories | EU National (non-UK Citizen)
Date of entry to the UK
(for non-UK students)
Course code* F3P6

2. Last updated: June 2021
Your chosen uni or college will be able to tell
you this if you don’t know it.
Campus code
If there is no campus code, leave blank
Point of entry*
This is the year of the course you will start at.
E.g. first year = 1, second year = 2, third year =
3.
1
Course start date*
(Format of DD/MM/YYYY)
Country of birth* England
Nationality* British
Disability*
Circle or highlight the options that applies to
you.
No disability | Autistic disorder | Blind/partial sight | Deaf/partial hearing |
Long standing illness | Mental health | Learning difficulty | Wheelchair/mobility
| Other disability | Multiple disabilities
Ethnicity*
Circle or highlight the option that applies to
you.
White | Gypsy, Traveller or Irish Traveller | Black – Caribbean | Black –
African | Black – Other | Asian – Indian | Asian – Pakistani | Asian –
Bangladeshi | Asian – Chinese | Asian – Other | White/Black Caribbean
| White/Black African | White and Asian | Other Mixed | Arab | Other
Declaration
I confirm that the information given on this form is true, complete and accSurate and no information
or other material information has been omitted. I accept that if this is not the case, UCAS shall have
the right to cancel my application and I shall have no claim against UCAS or any other higher
education institution or college in relation thereto. 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. You have the right to cancel this application. If
you decide not to take up your place at the university or college you must do this by informing the
university or college who have offered you the place as soon as possible.
Student’s signature:
Date:
This form is for institution information only - please do not send to UCAS.