Candidates No.

: _______( For Official Use)

APPLICATION FORM SUMMER SCHOLARS PROGRAMME (University of Notre Dame) 2013

Please attach a recent photograph here

The completed form is to be emailed BY THURS, 14 MAR 2013, 11 PM, to sandrahandojo@gmail.com along with required documents (scanned in pdf version).
Please delete appropriately wherever there is an asterisk [*]. If an item is not applicable, enter not applicable" or "N/A." A PERSONAL PARTICULARS Class: _________ City of Birth NRIC No. : : _______________

Name (as in NRIC) : Country of Birth Citizenship Sex Home Address : : : :

Date of Birth :

Home Tel No. Email address

: :

Handphone No. :

Subjects read in JC1 : H2 subject taken without O level background: _____________________________________

CHOICE OF TRACKS

Please indicate the preferred track which you would like to participate in (refer to Annex B) First Choice: Second Choice:

ACADEMIC RECORD

Details of GCE O-level results (or equivalent) Total number of subjects taken: _____________ L1R5: No. 1 2 3 4 5 6 * Delete where applicable. D ADDITIONAL INFORMATION (ESSAY) Subject English Maths Grade No. 7 8 9 10 11 12 Subject Grade

Essay 1: Please share some of your reasons for wanting to participate in the academic track you have selected as your first choice. In what ways do you feel prepared to contribute to the class and what you hope to gain from your summer experience at Notre Dame?

No. of words: ____________________ Essay 2 (in about 100 words): What are the significant experiences or accomplishments you have realized that have helped define you as a person?

No. of words: ____________________

Please submit the following (soft copy): Secondary School testimonial, Secondary School CCA record, GCE O-level Examination results or equivalent, and Any other documents which may support your application. Please submit ANNEX A in hard copy to your home tutor by THURS, 14 MAR 2013, 5 PM.

ANNEX A (To be submitted to your home tutor by THURS, 14 MAR 2013, 5 PM)

APPROVAL OF PARENT/GUARDIAN

I, _______________________________ *parent / guardian of _________________________ have read the details of the Summer Scholars Programme organised by University of Notre Dame (as described in Annex B) and approve my *son/daughter/wards application for participation.

I have no objection to *his / her participation if *he / she is selected.

_______________________ Signature of Parent/Guardian

_______________________ Name of Parent/Guardian

__________________ Date

RECOMMENDATION BY TUTOR

I *support / do not support the applicant in his/her application for the Summer Scholars Programme organised by University of Notre Dame. Remarks:

Name of Tutor:

Signature/Date:

Tutor, please submit Annex A to Ms. Sandra Handojo by Fri, 15 Mar 2013. Thank you.