2017 DIRECT SCHOOL ADMISSION SECONDARY (DSA-SEC) EXERCISE APPLICATION FORM
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1 2017 DIRECT SCHOOL ADMISSION SECONDARY (DSA-SEC) EXERCISE APPLICATION FORM APPLYING FOR: (Please indicate the talent area(s) that you are applying for) Growing the Entrepreneurial Mindset Nurturing Compassionate Leaders Please note that shortlisted candidate will have to attend two separate sessions of situational assessments if both talent areas are indicated. Section A: Student s Particulars Name of applicant: (as in official documents) Nationality: BC No. FIN Passport No.: Gender: Male Female Affix recent passportsized photograph here Date of birth: (dd/mm/yyyy) Place of birth: Contact Number: Home: Mobile: Residential Address: Mother Tongue: Chinese Malay Tamil Others Exempted Address: Race: Registration Number from MOE Customer Service Centre: (for candidates not studying in MOE mainstream schools) Please attach a photocopy of the MOE Registration Number Form (for candidates not studying in MOE mainstream schools) 1
2 Section B: Parent s / Guardian s Contact Details Name of Parent / Guardian: Relationship to Applicant: BC No. FIN Passport No.: Residential Address: (if different from above) Contact Number: Home: Address: Mobile: Section C: School Report (Conduct) Name of Primary School: Level Primary 4 Primary 5 Primary 6 (Mid Year) Conduct Grade Please attach copies of Primary 4-5 (End-of-Year Results) and Primary 6 (Mid-Year Results) containing conduct grade, referral letter(s) and testimonials. Award(s) if any: (example: ECHA, school-based Service Award, etc) Year Award 2
3 Section D: Co-Curricular Activity (CCA) CCA (Main and Other CCAs) Primary 5 Position Held Description of Participation and Achievements Primary 6 Please attach relevant copies of CCA records in schools and participation outside school (if any). Section E: Leadership Potential and Ability Leadership Roles Primary 5 Position Held Description of Participation and Achievements 3
4 Primary 6 Please attach copies of relevant leadership responsibilities, participation in leadership courses and projects, etc, in primary school and beyond. Section F: Participation in school - based or community - based projects Year No. of hours involved Brief description of the Project and Involvement Please attach copies of relevant records of community service rendered in primary school and beyond. 4
5 Section G: Involvement in programmes/competitions in Innovation and Entrepreneurship (Fill in this section if you have indicated Growing the Entrepreneurial Mindset as your talent area) Year Title of workshop / course / competition / enrichment Achievement (if any) Name of Organiser Please attach copies of relevant records of involvement. Section H: Personal Statement In the space below, in not more than 300 words, please describe yourself and provide with reasons why you want to apply to Edgefield Secondary School. You may want to cover the following points: (Attach additional sheet(s) if space is insufficient) - What are your aspirations? - Highlight personal attributes that will help you to be accomplished in your talent area. - How can you contribute to the school and the community in your talent area? If you have indicated interest in both talent areas, you will need to write for both talent areas. [You can choose to do a video instead, describing yourself with the above stated points]. 5
6 6
7 Section I: Declaration by Applicant and Parent / Guardian I, (Name of Applicant) declare that the information provided in this application is true. I understand that any false declaration will lead to disqualification. Signature of Applicant Date I, *Mr / Mrs / Mdm / Ms, the *parent / guardian of the applicant fully support my child s / ward s application for DSA to Edgefield Secondary School. I understand that once my *child / ward is successfully allocated to Edgefield Secondary School, my *child/ward will not be allowed to participate in the Secondary One Posting Exercise to opt for secondary schools, and are expected to honour the commitment to the allocated DSA-Sec school for the entire duration of the programme. My *child / ward will also not be allowed to transfer to another school after the release of the PSLE results. I understand that the school s decision is final and no appeal or correspondence will be entertained. Signature of parent / guardian Date *Delete where applicable FOR OFFICIAL USE Checklist: Items Application Form (completed and signed) Photocopy of MOE Registration Number Form (for candidates not studying in MOE mainstream schools) Personal Statement (written/typed or in video format) Copies of Primary 4 & 5 End-of-Year Results and Primary 6 Mid-Year Results, referral letter and testimonials. Copies of supporting documents (CCA records, certificates, community involvement records, leadership responsibilities, competitions, others) Received by: Tick ( ) Name of school staff Signature Date 7
Date of birth (day/month/year) Home Telephone No Student s H/p No Typical school s dismissal time
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