RVHS_2017_DSA_Application Form

Name of Applicant:
For Official Use
Reference No: 2017/
立 化 中 学 RIVER VALLEY HIGH SCHOOL
Tel: 65678115 Fax: 65677351
Email: [email protected]
6 Boon Lay Avenue
Singapore 649961
2017 DSA
APPLICATION
Please read these instructions carefully.
1. All applicants are to ensure that the requirements for P5 Year-End and P6 Mid-Year
Examination are fulfilled before applying.
2. Applicants must fulfil the following criteria to be shortlisted for school based selection
test and interview:
 At least 75% for overall percentage in both P5 Year-End and P6 Mid-Year
Examinations and an “A” grade for Chinese Language in P6 Mid-Year
Examination.
3. Complete all 8 sections (Sections A, B, C, D, E, F, G and H) in the application form.
Please attach additional details and/or evidence for Sections E and F if necessary.
4. Submission of application: you may submit this application form and supporting
documents via hardcopy or through email. If you apply through email, the original
supporting documents are required for verification on the day of the interview.
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
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a) Hardcopy submission: Submit the completed application form together with copies
of the required supporting documents (See Page 8 of Application Form) to:
RIVER VALLEY HIGH SCHOOL
6 Boon Lay Avenue
Singapore 649961
(Attention: 2017 DSA Application)
b) Email submission: Application forms and supporting documents may be submitted
via electronic mail to [email protected] . Please indicate "2017 DSA Application" in
the subject field. An acknowledgement email will be sent upon receipt of
application.
5. The deadline for submission is 30 June 2017 (Friday), 5 pm.
6. Please note that

Successful DSA-Sec students are NOT allowed to participate in the Secondary
One Posting Exercise to opt for secondary schools; and

Successful DSA-Sec students are also NOT allowed to transfer to another school
after the release of the PSLE results, as students are expected to honour their
commitment to the posted DSA school for the duration of the programme that
he/she is admitted into.
For Official Use
Reference No: 2017/
A
Name of Applicant:
PERSONAL PARTICULARS
Name of Applicant (in BLOCK letters)
Underline surname
Name in Chinese characters
(if applicable)
Please affix a recent
passport-size photo
NRIC or Passport Number
Foreign Student Pass
Number (if applicable)
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
2
Citizenship
Race
Religion
Date of Birth
Place of Birth
Gender (please tick)
 Male
 Female
B
ADDRESS & CONTACT NOS. OF APPLICANT:
Name of Street :
Block:
Unit / Apartment:
Postal Code
Home Tel No
Mobile Tel No
Email address
Parent’s mobile tel no.
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
(please specify father/ mother)
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C
APPLICATION GROUPS
You may apply for any of the talent areas. You may tick up to 2 boxes.
Group 1
 Badminton
 Basketball (Boys)
 Netball
 Softball
 Table tennis
 Volleyball (Girls)
 Wushu
Group 2
 Chinese Orchestra
 Choir
 CLDDS
 ELDDS
 Concert Band
 Dance (Chinese)
Group 3
 Info Comm
 Robotics
 Leadership
Group 4
 Scientific Investigation
 Environmental Science
 Innovation
Group 5
 Literacy (Writing)
 Communication (Speaking)
Group 6
 Numeracy
 Computer Programming
Candidates
should
possess
strong communication skills
with achievements in writing or
speaking
in
English
or
Mandarin.
Candidates should have attained
a high level of proficiency in
numeracy or computational
work.
Candidates should have attained
a high level of proficiency in
scientific/
environmental
research or displayed the ability
to engage in innovation or
problem-solving.
Note for all applicants: Achievements at the national/international level would be an advantage.
Applicants will need to attach evidence of achievement at an appropriate platform that illustrates a high
level
of
competence.
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
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Name of Applicant:
D
ACADEMIC RESULTS
Name of Primary School :
GEP: Yes/No*
(please delete accordingly)
Detailed Results
2016 Primary 5 Year-End
Overall Percentage
/ 100%
Band
Subject
2017 Primary 6 Mid-Year
/ 100%
Marks
Band
Marks
English Language
Higher Chinese
Chinese
Mathematics
Science
(Please attach copies of Pri 5 End-Year Exam Results and Pri 6 Mid-Year Exam Results.)
E
ACHIEVEMENTS IN TALENT AREA
Please list significant achievements and contributions in your talent area. Attach additional sheets if the
space provided is insufficient.
Talent
Type of Award
Year
awarded
Name of awarding
organisation
Evidence of
talent

2016

Eg. ABC Junior College
2017

Eg. XYZ Badminton Association
For sports,
please specify
achievements as
single, double,
team player or
reserve where
applicable

Eg. 2nd prize in Inter-School Mathematics
Competition
Eg. Team 1st Runners-up in Inter-School
Badminton Competition (2nd single player for
school team)
(Please attach copies of all relevant supporting documents.)
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
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Name of Applicant:
F
CCA AND LEADERSHIP
(Attach additional sheets if the space provided is insufficient.)
Areas
Leadership
Positions in
school
Year
Description
Eg. 2017
2016
Eg. Head Prefect
Sectional Leader, Trumpets Section
Co-curricular
Activities
Eg 2015-16
2017
Eg. Member, Band
School Basketball Team. Participated in ….
(Please attach copies of all relevant supporting documents.)
Name of Applicant:
G
PERSONAL STATEMENT
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
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We want to know more about you.
立化中学是一所提供综合课程的特选中学。试以不超过200字说明你选择立化中学的理由。
In about 150 words, please describe yourself, highlighting key qualities that support your
application:
Name of Applicant:
H
DECLARATION
I declare that the information provided on this application is true and complete to the best of my
knowledge. Photocopies of all relevant documents are enclosed. Any false declaration will
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
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render this application invalid. The School may request for the original documents for
verification.
Signature of Applicant
Date:
Signature of Parent / Guardian *
Date:
Name of Parent / Guardian *
* Please delete accordingly
DOCUMENTS TO BE SUBMITTED
Application Form (Duly signed by the applicant and parent / guardian)
Copies of P5 Year-End and P6 Mid-Year Examination results
Copies of other supporting documents such as CCA records, certificates, VIA
records, commendation letters or other achievements to support evidence of talent, if
any.
Please note that

Successful DSA-Sec students are NOT allowed to participate in the Secondary One
Posting Exercise to opt for secondary schools; and

Successful DSA-Sec students are also NOT allowed to transfer to another school after the
release of the PSLE results, as students are expected to honour their commitment to the
posted DSA school for the duration of the programme that he/she is admitted into.
River Valley High School 6 Boon Lay Avenue Singapore 649961
Tel: 65678115 Fax: 65677351 email: [email protected]
8