UNIVERSITY OF WESTERN SYDNEY Bachelor of Medicine/Bachelor of Surgery (MBBS) Prediction of Australian Tertiary Admission Rank (ATAR) Must be lodged by 30 September 2011  This form is to be completed and either faxed to 02 4620 3888 or mailed to Penny Lee, School of Medicine, UWS, Locked Bag 1797 PENRITH SOUTH DC NSW 1797. The form must reach the school office by 5pm AEST, Friday 30 September 2011.  This page is only to be completed for applicants in their final year of secondary school.  Applicants who have already completed Year 12 do NOT need to provide this as their actual ATAR, or equivalent, will be provided by UAC.  If you have difficulties submitting this form, or if you have any queries, please contact the School of Medicine directly on 02 4620 3928. Statement for School Principal Please note that this prediction will be used, along with the UMAT score, to determine whether this student may be invited to an interview before the actual HSC results are available. In final decisions about selection, the actual ATAR will always be used. Students whose predicted ATAR is below the admissions threshold but actual ATAR is at or above it, will be eligible to be invited to a late round of interviews. Details of Applicant: Student’s Last Name Student’s First Name Student’s UAC number (if known)

Please complete only one of the following five sections and circle one number only. This student is currently in Year 12 of secondary school. Based on their performance to date, I estimate that their Year 12 results will be close to:

1. NSW, ACT, VIC, SA, WA, TAS OR NT ≤ 92 93/94 ≥95.50 2. QLD ≤OP5 ≥OP4 3. New Zealand ≤94 ≥95 4. International Baccalaureate ≤34 35 ≥36 5. GCE “A” Levels or Malaysian STPM ≤ ABB ≥AAB Details of School Principal (or delegate) Full Name Signature Date School School Postcode School Stamp