AJC DSA Application Form 06

Anderson Junior College
Application for Direct School Admission (DSA) 2014
Please tick () the relevant category:

Sports CCAs*

Performing Arts CCAs*

Academic Excellence

Science Research
Badminton / Basketball / Bowling / Football / Hockey / Netball / Shooting / Squash /
Table Tennis / Track / Volleyball / Wushu
Chinese LDDS / Chinese Orchestra / Choir / Contemporary Dance / Indian Dance /
Music Club / StAJeWorks / Symphonic Band
* Please circle the relevant CCA
Section 1 – Personal Particulars
Name
Gender
*Male /
Female
affix a recent
Date of Birth
Address
passport-sized
NRIC / FIN Number
colour photograph
Home Phone
Email
of yourself
Number
Address
Please
here
Handphone Number
*Delete where inapplicable
Section 2 – Academic Details
Primary
PSLE Score
School
SAP / Express / IP /
Stream (circle one)
Secondary
Normal Academic
L1R5 for Sec 3 Mid-Year Examination
School
L1R5 for Sec 3 Year-End Examination
L1R5 for Sec 4 Mid-Year Examination
Section 3 – Contributions and Achievements
List your contributions and achievements in CCA and other areas, especially those in Secondary 3 or 4 and those
relevant to this application.
Activity
Year
Role (if any)
Achievement
e.g. SYF Arts Presentation, ABRSM Violin
e.g. Participant, Section Leader,
e.g. SYF Distinction, Grade 6, 4
Exam, National ‘B’ Div Volleyball
Vice Captain
position
th
Section 4 – Personal Statement
In about 200 to 250 words, write a personal statement that will enable us to better understand why you want to apply to AJC and
how you intend to contribute as a student in AJC.
Section 5 - Checklist of supporting documents to be submitted together with the Application Form:
S/No
Copy of document
1
Secondary 3 and Secondary 4 report cards
2
CCA records
3
Certificates of achievements / awards
4
Recommendation letter (if any)
Attached to this form ( please 
)
I declare that all the information provided in this application is true. I agree to abide by the decision of the Anderson
Junior College selection committee.
_______________________
Signature of applicant / Date
Note: Submit this form together with the supporting documents to the AJC General Office by 11 July 2014 (Fri). For
applicants who will be attending the selection trial or audition on or before 11 July, please submit the documents
directly to the CCA Teacher I/C during the selection trial or audition.

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