Questionnaire for Awardees
The Daily Star 19th ‘O’ & ‘A’ Level Award Presentation Ceremony, 2016-
2017
(PLEASE FILL THIS FORM IN BLOCK LETTERS)
1) Name:
………………………………………………………………………………………………………………………….
2) Address & Phone Number: …………………………………………………………………….
…………………
………………………………………………………………………………………………………………….………
3) Contact Number:
…………………………………………………………………………………………………….
4) E-mail ID:
……………………………………………………………………………………………………………….
5) Results:
O / A Level Session Number of ‘A’s Candidate ID
May / June 2016
November 2016
January 2017
May / June 2017
November 2017
6) Highest Marks (if any):
……………………………………………………………………………………………..
7) Ambition: ( Words Limit 15)
…………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………….………………
8) Favourite Quotation:( Words Limit 25)
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………..
…………………………
Please copy this page as per requirement
9) Signature & Date: ………………………………………………………………………
Note to Students:
* Please write down your name clearly behind the color photograph.
* Please attach 2-color passport-size photograph at the top-right corner of this questionnaire.
* Please ensure that the total number of the words in the ‘Ambition’ do not exceed 15 & ‘Favorite
Quotation’
sections do not exceed 25.
Please copy this page as per requirement