Authentication Form

COURSEWORK AUTHENTICATION SHEET

Specification/syllabus title:

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Specification/syllabus number:

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Centre Name (BLOCK CAPITALS):

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Centre Number:

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Candidate Name (BLOCK CAPITALS):

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Candidate Number:

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Examination series for which the candidate is entered: ______________________________________

Declaration of Authentication: I declare that the work submitted for assessment has been carried out without assistance other than that which is acceptable under the scheme of assessment. Signed (candidate):

_____________________________

Date:

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Signed (teacher):

_____________________________

Name of teacher:

_____________________________

Date:

_____________________________

Please attach this authentication sheet to the candidate’s internal assessment submission and ensure that is it visible on the front cover of the submission.

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