STEP registration form (for centres invoicing in £ Sterling) This form is designed as an aid for centres making entries via the Admissions Testing Service Entries Extranet. It will NOT be accepted as an entry by the Admissions Testing Service. 1. CENTRE DETAILS Centre name: Address: Contact name: Brasshouse Language Centre Centre number: 2 50 Sheepcote Street Birmingham B16 8AJ Telephone number: (including country code) 0121 303 1637 Fax number: (including country code) 0121 464 5375 Email address: Jo Johnson 0 1 9 Jo_O_Johnson@birmingham.gov.uk 2. CANDIDATE DETAILS Family name: Gender: First name(s): Male Date of birth: (dd/mm/yyyy) Female - UCAS ID / Candidate’s email: Candidate’s address: University applied to Telephone number: Course code College code College name University of Cambridge G 1 0 0 University of Cambridge S T E P University of Warwick S T E P n/a n/a Other S T E P n/a n/a / 9 3. ACCESS ARRANGEMENTS Not applicable Modified enlarged A4 question paper Maximum of 25% extra time Reader Braille question papers Scribe Supervised rest breaks Unmodified A3 question paper and answer sheet Use of laptop Bi-lingual dictionary without extra time Other (please state in box below) Reason for Access Arrangement request (evidence, statement from school/doctor etc.) 4. PAYMENT DETAILS Tick Paper 1 only Paper 2 only Paper 3 only Paper 1 & Paper 2 Paper 1 & Paper 3 Paper 2 & Paper 3 Paper 1, Paper 2 & Paper 3 Make cheques payable to* Direct debit payments to* Send enrolment form with payment or electronic proof of payment by 30 April 2013 to* Admissions Testing Service fee £44.25 £44.25 £44.25 £88.50 £88.50 £88.50 £132.75 Brasshouse Language Centre Brasshouse Language Centre Total fee including Centre’s fee (where applicable)* £70.00 £70.00 £70.00 £115.00 £115.00 £115.00 £160.00 Not Applicable Late entries will be accepted by the Admissions Testing Service from 1 - 24 May 2013. Late entries will be charged an additional £14.60 per paper. 5. CANDIDATE’S SIGNATURE AMB THE ADMISSIONS TESTING SERVICE TERMS Please note that by registering for STEP Mathematics, you are agreeing that data provided as part of the entry process may be passed to the Admissions Testing Service and any universities that you have applied to through UCAS, and that data may be used for research purposes in connection with admissions procedures. You also agree that if you obtain a place for a course where your STEP Mathematics result was used in the admissions process, then your university and UCAS may supply the Admissions Testing Service with data about your results in subsequent examinations whilst you are studying, unless you specifically notify the Admissions Testing Service in writing. The Admissions Testing Service will take reasonable care to keep candidates’ personal details anonymous. CENTRE’S TERMS* SIGNATURE ________________________________________________________ DATE ______________________ *Centres should update this part of the form to suit their centre’s local terms. PLEASE RETURN THIS FORM TO YOUR CENTRE. THIS REGISTRATION FORM SHOULD NOT BE RETURNED TO THE ADMISSIONS TESTING SERVICE. ALL ENTRIES FOR STEP MATHEMATICS MUST BE MADE BY REGISTERED CENTRES VIA THE ADMISSIONS TESTING SERVICE ENTRIES EXTRANET. Instructions for completing the registration form Candidate details Please give your name, gender, date of birth exactly as provided to the universities or UCAS. Please select the universities in the list that you have applied to, and give the course code that you are applying for: For Cambridge University, please give the College name from the following list: Christ’s Churchill Clare Corpus Christi Downing Emmanuel Fitzwilliam Girton Gonville & Caius Hughes Hall A B C Z D E F G Y 7 Jesus King’s Lucy Cavendish Magdalene Murray Edwards Newnham Pembroke Peterhouse Queens’ Robinson J K L M O N P U Q R Selwyn Sidney Sussex St Catharine’s St Edmund’s St John’s Trinity Trinity Hall Wolfson Open application V 3 S I X T 4 W 9 For Oxford University, please give the College name from the following list: Open application Balliol Brasenose Christ Church Corpus Christi Exeter Harris Manchester Hertford Jesus Keble Lady Margaret Hall Lincoln Magdalen OPEN BAL BNC CCH CCC EXT HMC HTF JES KBL LMH LIN MAG Mansfield Merton New College Oriel Pembroke Queen's St Anne's St Catherine's St Edmund Hall St Hilda's St Hugh's St John's St Peter's MAN MER NEW ORL PBK QNS STA STC SHE SHI SHU STJ STP Somerville SOM Trinity TRI University UNI Wadham WAS Worcester WOR Permanent Private Halls Blackfriars Campion Hall (M) Greyfriars Regent's Park St Benet's Hall (M) St Stephen's House Wycliffe Hall BKF CAM DRY RPK STB SSH WYC Universities applied to If you have applied to a university other than those listed above which has requested STEP, you should be entered for STEP under ’Other’ with the course code STEP. If you have applied to the University of Cambridge for a course other than G100 Mathematics, you should be entered under the ‘University of Cambridge’ with the course code STEP. Access arrangements If you are normally allowed access arrangements such as extra time or enlarged papers to take public examinations, please note this on your registration form. Please see below for a list of access arrangements available. If your access arrangement is not listed please provide more detail of it on the registration form. It is your responsibility to make your centre aware of any access arrangements you may need. Maximum of 25% extra time Braille question papers Unmodified A3 question paper and answer sheet Modified enlarged A4 question paper Reader Scribe Supervised rest breaks Use of laptop for Section 3 Other Requests for modified question papers (Braille, enlarged paper etc.) must be received by 2 April 2013. Further information relating to STEP Mathematics can be found at www.stepmathematics.org.uk