Serial No: / / .

Particulars of Student Appealing for Admission (Please submit this form to General Office by 15 Oct 2018, 5pm)

Level/Streamappealedforin2019:Sec*TwoExpressorSec*ThreeExpress

1

NameofStudent:

NRICNo:

Nationality:

DateofBirth:

LocalAddress:

2

NameofpreviousprimarySchool:

3

PSLEResults:

English:_____________________Maths:_____________________Aggregate:__________________

Science:____________________*CL/ML/TL:______________Stream:*Special/Express/Normal

4

Father’sName:

ContactNo:________________________(Hp)

EmailAddress:

_______________________(Home)

5

Mother’sName:

ContactNo:________________________(Hp)

EmailAddress:

_______________________(Home)

6

Guardian’sName:

ContactNo:________________________(Hp)

EmailAddress:

_______________________(Home)

* Please delete accordingly

Page 1 of 2

6. Why are you seeking admission to CHIJ Secondary School ? ( Please be specific as this will affect your chances of getting into the school.)

Name of person completing this form: ________________________________________ __________________ _____________ Signature Date Please attach the following documents:

1. PSLE Result Slips

2. Latest copy of Mid-year, & Final-year and CA Results

Thank you for completing this form We shall contact you as soon as we are able to make decision regarding your application

Page 2 of 2