A' Level Application Form - St. Mark's SSS Naminya

A' LEVEL APPLICATION FORM (Senior 5-6)

Academic Year: _________________

First Name *

Middle Name

Last Name *

Date of Birth *

Gender *

Religion

Denomination

Passport
Photo
(Attach Here)

CONTACT INFORMATION

Guardian/Parent Name *

Relationship to Student *

Guardian Phone Number *

Guardian Email

EDUCATIONAL BACKGROUND

Secondary School Attended (O' Level) *

UCE Year *

UCE Index Number *

UCE School Code

UCE Results (Enter grades for each subject)

Subject	Grade
English	_______
Mathematics	_______
Biology	_______
Chemistry	_______
Physics	_______
Geography	_______
History	_______
CRE	_______
Literature	_______
Commerce	_______

A' LEVEL SUBJECT COMBINATION *

Select ONE combination you wish to pursue:

PCM (Physics, Chemistry, Mathematics)
PCB (Physics, Chemistry, Biology)
MEG (Mathematics, Economics, Geography)
HEG (History, Economics, Geography)
LIT (Literature, History, Divinity)
ADM (Art, Divinity, Music)
BCM (Biology, Chemistry, Mathematics)

Day Scholar / Boarding *

DECLARATION

I hereby declare that the information provided in this form is true and accurate. I understand that any false information may lead to cancellation of admission. I agree to abide by the school's rules and regulations.

Parent/Guardian Signature: _________________________

Date: _________________

FOR OFFICE USE ONLY

Date Received:

Application No.:

Interview Score: