LPGS Collection Authorisation — Langley Park School for Girls

Full name of student *

Student candidate number: *

Tutor group (form):

I will be out of the UK on results day *

Yes

If you will be out of the UK, please provide a personal email address where we can send your statement of results. (If your LPGS email is showing, delete this and overtype with your own):

What are you collecting?
(Please choose as appropriate)

Certificate

Results

Please say whether you are collecting A-levels or GCSEs, or the Extended Project.

Please also list separately any vocational subjects that apply (e.g. Health & Social Care, Business CTEC, Creative iMedia, science or media BTECS) *

Full name of representative collecting on student’s behalf *

I, the above-named student, authorise the above-named representative to collect my certificates/results on my behalf. Upon collection my representative will bring their photo ID in order to verify their identity. (tick to accept) *

Yes

Send me a copy of this form

[Tick this box to confirm submission with X answers blank]

Please leave the next box blank or your submission will not be accepted: