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] 1 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) 3 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] 4 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] 5 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] 6 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] 7 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
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