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NAME:
2013
Be Part of the Learning Revolution
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APPLICATION FORM
A PERSONAL PARTICULARS (PLEASE USE BLOCK LETTERS. ALL INFORMATION IN PART A MUST BE FILLED)
B TYPE OF AWARD
(Please choose only one and indicate with a tick () in the boxes provided below.) Principals Awards 2013 @ Taylors College Subang Jaya Programmes offered: - Cambridge A Levels (CAL) - Canadian Pre-University (CPU) - South Australian Matriculation (SAM) Taylors College Sri Hartamas Awards 2013 Programmes offered: - Cambridge A Levels (CAL) - International Baccalaureate Diploma Programme (IBDP) - South Australian Matriculation (SAM)
FAMILY INFORMATION
Name of Parent / Guardian 1: Relationship: Occupation: Office Tel No.: E-mail Address of Parent / Guardian: Name of Parent / Guardian 2: Relationship: Occupation: No. of Siblings Still Schooling: Mobile Phone No.:
D
Town:
ACADEMIC QUALIFICATIONS
Year:
School / Institution:
Note: Please attach your Form 4 (Grade 10) and Form 5 (Grade 11) school examination results. (CERTIFIED TRUE COPY of school report card)
YEAR 2011
ESSAY
1. Please prepare an essay of not more than 300 words, typed on a separate sheet of paper. Topic: The future is here. How will the iPad and other digital devices change my learning experience? 2. Please indicate your full name and school on the top right hand corner. 3. Please attach your essay with this application form.
Deadline for submission: 16 July 2012 Submit your application form and documents by post to Taylors College at the following address: Principal's Awards 2013 @ Taylor's College Subang Jaya Taylor's College Sri Hartamas Awards 2013 Registry, Records and Scholarship Unit Student Central Taylors College No. 1, Jalan SS15/8 47500 Subang Jaya Selangor Darul Ehsan. Tel: 03-5636 2641
DECLARATION BY APPLICANT
I, (IC/ Passport No.) , declare that the information provided by me is true and correct. I understand and agree that Taylors College reserves the right to vary or reverse any decision regarding this application made, on the basis of incorrect or incomplete information. I hereby agree to abide by all Terms and Conditions set by Taylors College.
Signature of Applicant:
K VERIFICATION BY SCHOOL
Name of School Counsellor/ Assistant Principal/ Principal: Designation: Signature: FOR OFFICE USE ONLY Application verified & checked by: Signature: Name: Date:
*All information is correct at the time of printing May 2012.
Date:
School Stamp: