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DSA_ApplicationForm_2012

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					                           ADMIRALTY SECONDARY SCHOOL
                2012 Direct School Admission – Secondary (DSA-Sec) Exercise
                                 DSA-Sec Application Form



Instructions for Applicant

You will need approximately 20 minutes to fill up this form. Please ensure that the following
documents / items are attached to this form.

     1.     Attach a recent passport-sized photograph of applicant.
     2.     Fill in the spaces with relevant information.
     3.     Attach photocopies of
            a. Result slips of Primary 4 to Primary 6
            b. Evidence of participations, awards, achievements, etc
            c. Referral letter (if any - optional)
            d. Testimonial (if any - optional)
            e. Any other supporting documents

I.        APPLICANT’S PERSONAL PARTICULARS


 Name of Applicant:                             Gender: Male / Female*

                                                                                  Please affix a
                                                                                     recent
                                                                                  passport-size
 BC No. / FIN / Passport No.*                   Date of Birth:                     photograph



 Nationality:                                   Primary School:



 Name of Parent / Guardian*:                    NRIC of Parent / Guardian*



 Mother Tongue: Chinese / Malay / Tamil / Others / Exempted*


 Address:


 Contact No of Parent / Guardian:                        (Home)                            (Mobile)


 Email Address (if any):

                    Admiralty Secondary School. 31 Woodlands Crescent, Singapore 737916.
                                         Tel: 63651733 Fax: 63652774
                                                     1
II.      TALENTS (Please tick the relevant boxes)


               ROBOTICS SKILLS                                       ENTERPRISE SKILLS


 LEGO NXT Construction                   [       ]       Presentation                             [      ]


 LEGO RCX Construction                   [       ]       Webpage Design                           [      ]


 LEGO Mindstorm / ROBOLAB                [       ]       Journal Writing Presentation             [      ]


 Vex Robotics System                     [       ]       Research                                 [      ]


 I-Sobot Humanoid                        [       ]       Entrepreneurial Marketing                [      ]


 Others (Please Specify):                                Others (Please Specify):


 _____________________________________                ________________________________________


III.     ACHIEVEMENTS
         Please state any relevant competition participation. Name the awards achieved (if
         any) and the year of achievement.


       YEAR        LOCAL /          NAME OF COMPETITION / ACTIVITIES                         LEVEL OF
                 INTERNAT’L                                                                ACHIEVEMENT




                    Admiralty Secondary School. 31 Woodlands Crescent, Singapore 737916.
                                         Tel: 63651733 Fax: 63652774
                                                     2
IV.    CCA RECORDS
       Please list down the CCA that you participated in primary school and the level of
       attainment (E.g., Club President, Chairman, Club member, etc).


      YEAR                       NAME OF CCA                               LEVEL OF ATTAINMENT




V.     WRITEUP OF APPLICANT
       In not more than 200 words, describe and highlight any other strengths / experience
       that you possess that support your DSA application. Please attach evidences
       overleaf, if necessary.



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                  Admiralty Secondary School. 31 Woodlands Crescent, Singapore 737916.
                                       Tel: 63651733 Fax: 63652774
                                                   3
V.     DECLARATION



 I, ___________________________________________________________, parent/guardian* of,

 __________________________________ ( Name of Applicant), declare that all the information

 provided in this application is true. I agree to abide by the decisions made by the DSA Selection

 Committee.

 I understand that once my child/ward is successfully allocated to Admiralty Secondary School,

 he/she will not be allowed to participate in the Secondary One Posting Exercise, and will not be

 allowed to transfer to another school after the release of the PSLE results.


 Signature of Parent/Guardian*:       NRIC/Passport No.                       Date:




VI.    OFFICIAL USE (Please tick the relevant boxes)


 1. Application (Completed and signed).                                                    [   ]


 2.   Photocopies of result slips from P5 (Overall) and P6 (Mid Year).                     [   ]


 3.   Evidences of participation in competitions, awards, achievements, etc.               [   ]


 4.   Any other supporting documents.                                                      [   ]




         Received By: ……………………………………..                                    Date: …………………….
                          (Name of Staff)




                    Admiralty Secondary School. 31 Woodlands Crescent, Singapore 737916.
                                         Tel: 63651733 Fax: 63652774
                                                     4

				
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