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41 Clementi Avenue 1 Singapore 129956 Tel: 67788303 Fax: 67751956

E-mail: Website: http://www.nanhuahigh.moe.edu.sg

DIRECT SCHOOL ADMISSION - SECONDARY

DSA APPLICATION FORM

Submission Deadline: 1 July 2011 (5.00pm)

Section I: Personal Particulars /
Please attach passport-size photograph here
Statutory Name: / Name in Chinese Character:
(if applicable)
BC No./FIN/Passport No: / Gender:
Male / Female / Nationality:
* CEN / REG No. from MOE Customer Service Centre
(for students currently not studying in our national schools): / Date of Birth:
Home Address:
Postal Code: ( )
E-mail Address: / Contact No:
Mobile:
Home:
Section II: Option for DSA
Area to be considered for direct admission based on CCA achievement:
(Please select only ONE area with a ‘ü’)
¨ Chinese Drama ¨ Cross-country
¨ Chinese Orchestra ¨ Badminton – Boys / Girls
¨ Choir ¨ Basketball – Boys
¨ Dance ¨ Netball – Girls
¨ English Drama ¨ Softball – Girls
¨ Guzheng ¨ Table Tennis – Boys / Girls
¨ Symphonic Band
¨ Visual Arts ¨ Chinese Calligraphy

* Students currently not studying in our national schools must obtain this CEN / REG Number from MOE Customer Service Centre and produce the document for verification during application

Section III: Academic Results
Name of Primary School: ______
Primary 6 School Examination Results:
(* Note: You need to attain at least 70% each for 3 or more subjects)
Subject / Percentage Score
(Mid-year)
1. English Language
2. Mathematics
3. Science
4. Chinese
5. Higher Chinese, if applicable
6. Others (Please state: ______)
Section IV: CCA Record and Achievements in Primary School
CCA in Primary School:
1. ______2. ______
S/N / CCA Activity/Competition Participated In / Year / Level of Participation/ Award / Position Attained
Section V: Music/Dance Qualification (if applicable)
S/N / Highest Grade Attained (State Theory / Practical) / Year / Instrument
(eg. piano/violin), if applicable / Name of Organisation Conducting the Examination (eg. ABRSM, RAD, Trinity College and NAFA)
Others:
Section VI: Other Awards related to special music/dance/drama/sports skills
(eg. National Music Competition: 1st in Erhu Junior Section)
S/N / Name of Award / Year / Name of Organisation Giving the Award
Section VII: Declaration by Applicant
I declare that:
1. I have not knowingly withheld facts and information in this application
2. I understand that if any information is false and incomplete, my application
will be rejected
______
Name of Applicant Signature Date
Endorsement by Parent/Guardian:
______
Name of Parent/Guardian Signature Date
______
NRIC/Passport No. Contact No.
FOR OFFICIAL USE
Application form checked and received by:
______
Name & Signature

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