FOR OFFICE USE: APPLICATION No

SIR MICHELANGELO REFALO

SIXTH FORM

An Institute for Further Education

______

Matsec Course

APPLICATION FORM 2015 - 2017

Name and Surname of Applicant:

I.D.Card No. / Passport No.:

For Office Use

Applicants are required to present the following:

Secondary Education Certificates (result slips - original and 1 copy of the document)

School Leaving Certificates (Original and 1 copy of the document)

I.D. card (original and 1copy of the document)

3 Passport size photo

QUALIFIED: / 1st CHECK / 2nd CHECK / 3rd CHECK

This Form Should Be Submitted At Sir Michelangelo Refalo Sixth Form

SIR MICHELANGELO REFALO

SIXTH FORM

VICTORIA GOZO

APPLICATION FORM 2015 - 2017

1. Surname / 2. First Name
3. Mailing Address
Post-Code / Tel. No. / Other / Mobile No.
E-mail Address:
4. Date of Birth (d/m/y) / 5. Nationality
(IF DUAL PLEASE PUT DOWNBOTH)
6. Identity Card No. / 7. Father's Name:
Mother's Name:
8. Qualifications: SEC Examination at Grade 5 or better or equivalent (details of results obtained)
COMPULSORY SUBJECTS
SUBJECT / EXAMINING BODY / SESSION / RESULT
(MONTH & YEAR) / (GRADE OR MARK)
English Language
Maltese / University of Malta
Mathematics
Select Science Subject: PhysicsChemistryBiology
Another subject:
Another subject:
9. Other Qualifications in excess of Entry Requirements.
10. LastSchool Attended
11. Please indicate which degree course you intend to pursue at the University.

Note: Applicants are advised to consult the Special Course Requirements for guidance regarding subjects chosen.

12. APPLICANTS ARE REQUIRED TO CHOOSE ONE SUBJECT FROM EACH OF GROUPS 1, 2, AND 3 AND TWO OTHER SUBJECTS FROM ANY OF THE FOUR GROUPS. TWO OF THE FIVE SUBJECTS CHOSEN MUST BE AT ADVANCED LEVEL AND THE OTHER THREE SUBJECTS AT INTERMEDIATE LEVEL.

Group 1

Maltese, Arabic, English, French,Italian, Latin, German, Spanish.

Group 2

Marketing+, Accounting+, Economics+, Geography, History, Philosophy, Psychology ++, Religious Knowledge, Sociology, Classical Studies++

+ not more than two of Accounting, Economics and Marketing may be chosen.

++ Subject is only offered at Intermediate Level.

Group 3

Applied Maths (Mechanics), Biology, Chemistry, Physics, Pure Maths , Environmental Science+

+ Environmental Science is only offered at Intermediate Level and may not be taken with Biology, Chemistry or Physics.

Group 4

Art, Computing+, Information Technology+, Music, Engineering Drawing++,Home Economics and Human Ecology, Physical Education (PE) +++, Theatre and Performance+++.

+ Computing may not be taken with Information Technology

++ At Intermediate Level the subject is known asEngineering Drawing and Graphical Communication.

+++ Subject is only offered at Intermediate Level

SYSTEMS OF KNOWLEDGE - Compulsory Subject

13. APPLICANT'S CHOICE OF SUBJECTS:

Please insert subjects in alphabetical orderPlease insert subjects in alphabetical order

FROM
SUBJECT / GROUP NO
J
FROM
SUBJECT / GROUP NO

ADVANCED INTERMEDIATE

ADVANCED

INTERMEDIATE

IT IS IN YOUR INTEREST TO ENSURE THAT YOU HAVE CHOSEN AT LEAST ONE SUBJECT FROM EACH OF GROUPS 1, 2 AND 3 LISTED ABOVE.

(To be completed by applicant)

14. CONTACT PERSON IN CASE OF EMERGENCY
1. Surname: / Name:
Telephone/Mobile No.: / Relationship to Applicant:
E-Mail:
2. Surname: / Name:
Telephone/Mobile No.: / Relationship to Applicant:
E-Mail:
15. Disclosure of Personal data to Third Parties
Students' personal data (name, address, telephone nos., e-mail, course) may be given to third parties for research
purposes, if in the opinion of the Head, it is in the students' interest to do so. Would you agree to this?

Tick as appropriate. /
Yes /
No
16. Declaration:
I declare that the information given is correct and that the original certificates presented with this applicationhave been returned to me.
[to be signed at school] [to be filled at school]
Applicant's Signature / Date