Student’s details
Surname:………………………………………………………………………………………………
Other Names:………………………………………………………………………………………….
School currently attending:………………………………………….. Date of Birth:……/…../……
You may opt for one or more Academies and you should number your choice of Academies in order
of your preference (01, 02, 03,……..12):
Name of Academy Order of preference
Dr. Maurice Curé State College, St Paul Street, Vacoas…………………………….
Droopnath Ramphul State College, Souvenir, Calebasses……………………………………
Forest Side SSS (Girls), Forest Side……………………………………………..…….
GMD Atchia State College, Boulevard Pitot Street, Monneron Hill, Port Louis……….
John Kennedy College, Vuillemin, Beau Bassin……………………………………..
Mahatma Gandhi Institute, Moka………………………………………………….….
Queen Elizabeth College, Vandermeersch Street, Rose Hill…………………………..
Royal College Curepipe, Royal Road, Curepipe………………………………………
.
Royal College Port Louis, Cassis, Port Louis…………………………………………..
Sir A. R Osman State College, Closel Road, Phoenix……………..………………….
Sir L. Teelock SSS, Opposite Stadium, Central Flacq………..………………………..
S. Bissoondoyal State College, Rose Belle………….…………………………………
Name of Responsible Party:……………………………………………………………………………..
NIC:
Telephone Number:……………………………………… Mobile Number:…………..…………….
Signature:………………………………………… Date:…………………………