Application No.
(for office use)
SIR M.A. REFALO CENTRE FOR FURTHER STUDIES
APPLICATION FORM 2014 - 2016
MATSEC COURSE
Name and Surname of Applicant: BORG JOSEPH
I.D.Card No. / Passport No.:
000097G
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 2 copies of the document)
I.D. card (original and 2 copies of the document)
3 Passport size photo
Bank Account (Savings Account)
1st CHECK
2nd CHECK
3rd CHECK
QUALIFIED:
THIS FORM SHOULD BE SUBMITTED AT SIR M.A. REFALO CENTRE FOR FURTHER STUDIES
ATTACH
SIR M.A. REFALO CENTRE FOR FURTHER STUDIES
VICTORIA GOZO
PHOTOGRAPH
HERE
APPLICATION FORM 2013 - 2015
1. Surname
BORG
3. Mailing Address
100, CHURCH STREET , VICTORIA
Post-Code
VCTXXXX
E-mail Address:
[email protected]
2. First Name
Tel. No.
4. Date of Birth (d/m/y) 31/12/1997
21551582
5. Nationality
JOSEPH
Other / Mobile No. 99999990
MALTESE/ AMERICAN
(IF DUAL PLEASE PUT DOWN BOTH)
6. Identity Card No.
000097G
7. Father's Name:
Mother's Name:
PAUL
MARIA
8. Qualifications: SEC Examination at Grade 5 or better or equivalent (details of results obtained)
COMPULSORY SUBJECTS
SUBJECT
SESSION
EXAMINING BODY
RESULT
(GRADE OR MARK)
(MONTH & YEAR)
UNIVERSITY OF MALTA MAY 2013
3
MAY 2013
5
Mathematics
UNIVERSITY OF MALTA MAY 2013
1
Select Science Subject: Physics
UNIVERSITY OF MALTA MAY 2013
2
Another subject: FRENCH
UNIVERSITY OF MALTA MAY 2013
5
Another subject: HISTORY
UNIVERSITY OF MALTA MAY 2013
3
English Language
Maltese
University of Malta
9. Other Qualifications in excess of Entry Requirements.
ITALIAN
UNIVERSITY OF MALTA MAY 2013
ECDL
10. Last School Attended
JAN 2013
SACRED HEART SEMINARY
11. Please indicate which degree course you intend to pursue at the University.
B. COM
4
PASS
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 as Engineering 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 order
Please insert subjects in alphabetical order
FROM
FROM
ADVANCED
ADVANCED
SUBJECT
GROUP NO
ACCOUNTS
ECONOMICS
2
SUBJECT
GROUP NO
INTERMEDIATE
MALTESE
1
INTERMEDIATE
COMPUTER
4
INTERMEDIATE
PHYSICS
3
2
J
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
BORG
1. Surname:
PAUL
Name:
Telephone/Mobile No.: 11111110
Relationship to Applicant: FATHER
E-Mail: [email protected]
2. Surname:
BORG
MARIA
Name:
Telephone/Mobile No.: 77777777
Relationship to Applicant: MOTHER
E-Mail: [email protected]
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
application have been returned to me.
[to be signed at school]
Applicant's Signature
[to be filled at school]
Date