2006 Dsa Application Form

Secondary 1 2007 DSA APPLICATION FORM To be submitted to SCGS with supporting documents by 5.00 pm Friday 7 July 2006

CANDIDATE’S PARTICULARS

Statutory Name (as in BC/ID) : ________________________________________________ BC / FIN / Passport No.*: ___________________

Date of Birth : ___________________

Passport No. and MOE DSA Registration No. : __________________ / ________________ (For candidates who are currently not in National schools)

Nationality : ______________________________ Gender : Female Primary Sch : _______________________________________________________________ Mother Tongue : CL/ML/TL/Other/Exempted * Address : __________________________________________________________________ __________________________________________________________________________ Contact Tel : ________________________ email : ________________________________

PARENTS’ PARTICULARS Father’s Name : ____________________________________________________________ Occupation : _________________________ Nationality : ___________________________ Address (if different from above) : ______________________________________________ Contact Tel : _________________________ email : ________________________________ Mother’s Name : ____________________________________________________________ Occupation : _________________________ Nationality : ___________________________ Address (if different from above) : ______________________________________________ Contact Tel : _________________________ email : _______________________________

190 DUNEARN ROAD • SINGAPORE 309437 • TELEPHONE: 62527966, FAX: 62523076

ACADEMIC RECORD / STRENGTHS Please attach photocopy of Primary School academic records from Pr 4 - 6 Academic Achievements / Award (Attach Copies of Awards) Year Name of Award/Achievement Level (National / Inter-school / IntraSchool / cohort / class)

CO-CURRICULAR AREAS (Other areas of interests pursued within or outside school which may range from Nature Society Activities to Arts or other clubs or Sports activities) Achievements / Award (Attach copies of documents verifying Awards) Year Name of Award/Achievement Level (National / Inter-school / IntraSchool / cohort / class)

190 DUNEARN ROAD • SINGAPORE 309437 • TELEPHONE: 62527966, FAX: 62523076

KEY AREA OF INTEREST FOR THE PURPOSE OF THE DSA (Please do not mark more than 2 areas. Prioritise as 1 & 2 in this case and attach copies of supporting documents – no certification necessary) ACADEMIC

(Please tick or indicate Priority 1 & 2)

SPECIFIC SUBJECT AREA

Science Mathematics EL Language Arts SPORTS

COMPETITION LEVEL / EXPERIENCE

Badminton Basketball Gymnastics Netball Squash Swimming Tennis PERFORMING ARTS CCA

COMPETITION LEVEL / EXPERIENCE

Band Choir Dance Drama Handbells String Ensemble OTHER AREA (Specify eg Prefect or other leadership)

DETAILS

The applicant agrees to commit herself in this area if selected. We, the undersigned parents and the applicant, affirm the accuracy of the information given above, and understand that the school’s offer to admit the applicant under the Direct School Admission exercise may be conditional upon her commitment to participate in the particular activities required of her by the school for the duration of her studies there. No change to this should be effected without the consent of the school. We have no objection to the school contacting the referee directly for information or clarification with regard to the applicant.

________________________ ______________________ _________________________ Signature of Father/Guardian Signature of Mother Signature of Applicant NRIC/Passport No. : NRIC/Passport No. : ___________________

______________________

190 DUNEARN ROAD • SINGAPORE 309437 • TELEPHONE: 62527966, FAX: 62523076

OPTIONAL THIS SECTION SHOULD BE COMPLETED IN CONFIDENTIALITY AND SEALED IN A SEPARATE ENVELOPE BY THE REFEREE WHO SHOULD NOT BE A RELATIVE OF THE APPLICANT Name of Candidate : ________________________________________________________ Name of School : ___________________________________________________________ Name of Referee : ___________________________________________________________ Occupation : ______________________ Address : __________________________________________________________________ Contact Tel : _______________________ email : _________________________________ No. of years applicant known to Referee : _______ In what capacity? __________________ Please comment on the applicant’s character, talent in the DSA focus area applied for and other relevant traits. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

I have no objection to Singapore Chinese Girls’ School contacting me for further clarification and information on the applicant.

_______________________________ Signature of Referee

Date : _______________

190 DUNEARN ROAD • SINGAPORE 309437 • TELEPHONE: 62527966, FAX: 62523076