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De Mazenod College,

Kandana, Sri Lanka Application Form for the Grade 12 – 2020/22

Closing Date: 15th May 2020

|01 |Name in Full : | |

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|02 |Date of Birth : | |

|03 |Address : | |

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|04 |Gender : | |NIC No. : | |

|05 |Religion : | |School No : | |

|06 |Present School : | |

|07 |Telephone : | |Mobile No: | |

|08 |Father’s Name : | |

| |Occupation : | |Date of Birth : | |

| |Office Address : | |

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| |NIC No : | |Telephone : | |

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|09 |Mother’s Name : | |

| |Occupation : | |Date of Birth : | |

| |Office Address : | |

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| |NIC No : | |Telephone : | |

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|10 |Results obtained in G.C.E. (Ordinary Level) Examination |Index No : | |

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| |Subject |

| |Results |

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| |Subject |

| |Results |

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| |1 |

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| |6 |

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| |2 |

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| |7 |

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| |3 |

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| |8 |

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| |4 |

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| |9 |

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| |5 |

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|11 |Subject Stream you hope to follow (Please refer other side for details) |

| |1st Choice | |2nd Choice | |

| |Medium : | |

|12 |Details of the extracurricular activities you attend at present |

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| |For BIO SCIENCE |

| |(Chemistry / Physics / Biology ) |

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| |At least 8 A’s including Mathematics and Science. |

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| |For PHYSICAL SCIENCE |

| |(Chemistry / Physics /Combined Maths / ICT) |

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| |At least 8 A’s including Mathematics, ICT and Science. |

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| |For COMMERCE (Sinhala & English Medium) |

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| |COMMERCE I |

| |(Business Statistics/Accounts/Economics) |

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| |At least 6 A’s with A or B for Mathematics and at least C for Business Studies. |

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| |COMMERCE II |

| |(Business Studies/Accounts/Economics or ICT) |

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| |At least 6 A’s with A or B for Mathematics & ICT and at least C for Business Studies. |

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| |For ARTS |

| |Pass O/L Exam in six subjects with Maths and 4 A’s |

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| |Select one subject each from following subject combinations |

| |Political Science/Mass Media/Economics/French/Japanese |

| |Sinhala Language/Logic/ English Literature/ Geography / ICT |

| |History / Christianity / Dancing / Eastern Music/Western Music/Art/Drama |

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| |N.B For. English. Literature - ''A'' pass in English. Literature in O/L |

| |For French - “A” pass for English Language in O/L |

| |For ICT - “B” pass for ICT in O/L |

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| |I CERTIFY THAT THE PARTICULARS FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. |

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| |……………………………… ……………………. ……………………………………. |

| |Signature of the student Date Signature of Parent/Guardian |

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| |PLEASE NOTE : SIGNATURES ARE NOT REQUIRED TO SUBMIT THE APPLICATION |

| |VIA E-MAIL |

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