Eligibility Requirements:



Great Bay Charter School

Student Application Materials

2021-2022

Admission Process: The admission process at Great Bay Charter School (GBCS) will include a review of the information provided in the student’s application materials and an opportunity for the student and parent(s) to meet and interact with a member of our staff. In most cases this will involve an interview/information session with the Executive Director or an Assistant Director.

Essentially, this process has been designed to help you/us determine the student’s potential for success at Great Bay Charter School, overall ability to contribute positively to his/her learning and the overall learning community, and the school’s ability to meet the student’s individual academic needs. If your student has an Individualized Education Plan (IEP) with his/her district of residence and receives services within that IEP, it is strongly suggested to communicate with your resident school district about your consideration of enrollment at GBCS to ensure that these services will continue to be provided in a manner that is logistically reasonable for the student and his/her program at our school. Possessing a current plan (IEP or 504) plays no role in our decision.

During our spring open enrollment period (for the following school year), if there are more applicants than available openings, we will conduct a lottery to determine acceptance for open slots from qualified applicants. A waiting list for available openings will be maintained as necessary; admission will be open to applicants on a rolling basis as space is available.

Residence: Eligible students must be residents of New Hampshire.

Admissions Procedure: Sections I, II and III of this admissions package and any other supporting materials should be completed and delivered by mail, fax or email to the following:

Great Bay Charter School

30 Linden Street

Exeter NH 03833

(Fax) 603-775-8528

(Email) info@

Section IV is to be completed by an adult who knows and regularly works with the student. (teacher, coach, counselor, advisor, or school administrator, etc. of the student’s choice.) He or she may send this form via mail, fax, email directly to the address above in a separate envelope or it may be included with Sections I, II, and III submitted by the applicant.

Great Bay Charter School shall not discriminate in its education programs, activities or employment practices on the basis of race, color, national origin, age, sex, sexual orientation, religion or handicap under the provisions of Title VI of the Civil Rights Amendment of 1972, and Section 504 of the Rehabilitation Act of 1973. Any person having inquiries concerning the school’s compliance with the regulations implementing these laws may contact an Executive Director or the Chair of the Board of Trustees.

Great Bay Charter School

Section I: 2021-2022 STUDENT APPLICATION FORM

[To be completed by both the student applicant and parent(s)]

I. Student Information

Last Name________________________________ First___________________________ Middle______________

Date of Birth ______/______/______ Gender: Male _______ Female _______

Town & State of Birth___________________________________________________________________________

Legal Residence_________________________________ City ____________________ State____ Zip__________

Mailing Address _____________________________________________________________________________

City_________________________________________ State ______________ Zip_______________

Home Telephone Number_______________________________

E-mail Address (optional) _______________________________

II. Parent/Legal Guardian Information

Mother or Legal Guardian Name__________________________________________________________________

Legal Residence_________________________________ City ____________________ State____ Zip__________

Mailing Address ________________________________ City____________________ State ____ Zip__________

Home Telephone________________________________ Work/Cell Phone________________________________

Email Address_______________________________________ Legal Custody of Student Yes _____ No _____

Mother or Legal Guardian Signature________________________________________Date______/_______/______

Father or Legal Guardian Name__________________________________________________________________

Legal Residence_________________________________ City ____________________ State____ Zip__________

Mailing Address ________________________________ City____________________ State ____ Zip__________

Home Telephone________________________________ Work/Cell Phone________________________________

Email Address_______________________________________ Legal Custody of Student Yes _____ No _____

Father or Legal Guardian Signature________________________________________Date______/_______/______

III. Current School Information

Current School Name_________________________________________________________________________

School Address______________________________________________________________________________ City____________________________________________State______________Zip_______________

School Telephone Number______________________________________

Current grade level _______

Anticipated grade level entering/in 2021-2022 school year ______ Years at present school ________

If enrolled in current school less than one year, identify your previous school. ___________________________

IV. Grades

Please provide a copy of the most current progress report.

| |Current Quarter (Approx) |Previous Quarter |

|Science | | |

|Math | | |

|English | | |

|Social Studies | | |

|Other | | |

|Other ______________ | | |

V. Attendance

Approximate number of absences this school year to date: ________________________

If more than 5 days, please briefly explain.

In addition to a full day traditional program we are interested in (circle all that apply):

Extending Learning Opportunities (out of school, i.e, music lessons, karate, college classes)

Internship Opportunities (grades 9-12)

Career and Technical Opportunities (grades 9-12)

Summer Session

Summer Camp

Great Bay Charter School

Disclosure Statement

The application process is designed to ensure that the applicant and his/her family and school personnel are able to determine whether the school is an appropriate fit for the student and vice versa. Our school has a unique staff, structure, and desire to work with students to help them become college ready, but success is also dependent upon the student’s readiness and willingness to be an active participant in their education and be a positive member of the school community. We seek and encourage any student who wants to be an active participant in his/her education and positive contributor to our school community to apply.

It is our expectation that Great Bay Charter School students will:

• attend school regularly and each class as scheduled

• aspire to college or other post-secondary educational opportunities and will work hard to become “college or career ready”

• practice respectful behavior – show respect to each member of the community (students and adults alike) and respect the physical environment in which we work

• be productive – first and foremost, we are a school. Your job as a student is to progress with your learning and meet competencies in a timely fashion. That means coming to the table ready and willing to work

• turn in all project work/assignments as evidence of learning

• ask for help when they need it

• actively participate in the development of Personalized Learning Plan

• support their school community through participation in community building and fundraising activities

It is our expectation that Great Bay Charter School families will:

• partner with our school to support their student’s individual academic, social, and emotional growth

• participate in the development and monitoring of the student’s Personalized Learning Plan

• ensure that the student attends school daily as required by law and communicate with school personnel when this is not possible.

• communicate with school personnel when issues arise

• support their school community through participation in community building and fundraising activities

• be proactive in communicating with their local school district related to their student’s IEP (if applicable)

Great Bay Charter School shall not discriminate in its education programs, activities or employment practices on the basis of race, color, national origin, age, sex, sexual orientation, religion or handicap under the provisions of Title VI of the Civil Rights Amendment of 1972, and Section 504 of the Rehabilitation Act of 1973. Any person having inquiries concerning the school’s compliance with the regulations implementing these laws may contact an Executive Director or the Chair of the Board of Trustees.

We have read and certify that all information and responses provided in this application are presented accurately. I acknowledge that the school will seek academic and disciplinary records for the purpose of facilitating class/grade placement, transcript preparation, and confirming prior school discipline. Any additional information discovered in the future about the existence of prior disciplinary suspension(s) and/or expulsion(s) not disclosed in this application may result in the immediate termination of enrollment status at the discretion of the Executive Director.

Student

Signature___________________________________________________________ Date______________

Parent/Guardian

Signature___________________________________________________________ Date______________

Great Bay Charter School

Section IIA: STUDENT QUESTIONNAIRE

(To be completed by the student applicant)

Student Name______________________________________________________________

Please circle the number corresponding to your agreement with the following statements:

1 2 3 4 5

Strongly Somewhat Neutral Somewhat Strongly

Disagree Disagree Agree Agree

1. Through my best effort, I will

“take ownership” of my learning. 1 2 3 4 5

2. I will work hard with my teachers 1 2 3 4 5

to demonstrate my knowledge and skills.

3. I plan to go to school beyond high school. 1 2 3 4 5

(a college or post-secondary program)

4. I am successful when I can show 1 2 3 4 5

what I know by doing.

5. I will be respectful of myself, my 1 2 3 4 5

classmates, my teachers, and my school.

6. If I struggle with school work, I 1 2 3 4 5

will ask for help before I get overwhelmed.

7. I will benefit from a greater emphasis on 1 2 3 4 5

project-based learning.

8. I currently have a strong relationship 1 2 3 4 5

with a school adult.

9. I will be a positive contributor to the 1 2 3 4 5

school’s learning community.

10. I will attend school regularly. 1 2 3 4 5

Great Bay Charter School

Section IIB: STUDENT QUESTIONNAIRE (continued)

(To be completed by the student.)

Student Name______________________________________________________________

Shorter Open Response: Please respond to each of the following questions. (Use a separate piece of paper if necessary).

1. What school-based co-curricular interests do you have (clubs, activates, sports, etc)?

2. What factors might cause you to struggle in school?

3. What are your main interests or hobbies outside of school?

4. What will you contribute to the Great Bay Charter School learning community?

5. What subject areas within school most interest you? Why?

6. Have you ever been suspended or expelled from school? ( ) yes ( ) no

If yes, describe the circumstances.

Great Bay Charter School

Section IIB: STUDENT QUESTIONNAIRE (continued)

(To be completed by the student.)

Student Name______________________________________________________________

Open Response: Please respond to each of the following questions (Use a separate piece of paper if necessary.)

1. Describe a past learning experience (in or out of school) that was powerful, interesting, and/or successful for you. Why did this experience make the impression it did?

2. What have been your greatest challenges in school? How have you worked to overcome them?

Great Bay Charter School

Section IIIA: PARENT QUESTIONNAIRE

(To be completed by the applicant’s parent/guardian.)

Please circle the number corresponding to your agreement with the following statements:

1 2 3 4 5

Strongly Somewhat Neutral Somewhat Strongly

Disagree Disagree Agree Agree

1. My student will benefit from a smaller 1 2 3 4 5

learning environment.

2. My student will benefit by having an 1 2 3 4 5

adult advisor.

3. My student will benefit from a greater 1 2 3 4 5

emphasis on project-based learning.

4. I will be an active partner with school 1 2 3 4 5

staff working with my student.

5. I believe grades should be based upon 1 2 3 4 5

products in which learning is demonstrated.

6. I will help my student to set and meet goals 1 2 3 4 5

and will participate in his/her personalized

learning plan process.

7. I will ensure that my student attends school 1 2 3 4 5

regularly.

8. I will be an active community member 1 2 3 4 5

and will encourage my student’s active

engagement as well.

Great Bay Charter School

Section IIIB: PARENT QUESTIONNAIRE (continued)

(To be completed by the applicant’s parent/guardian.)

Student Name_______________________________________________________________

Please respond to each of the following questions. (Use a separate piece of paper if necessary.)

1. List/describe your child’s strengths as a student.

2. Please describe the learning environment in which your child would be most successful.

3. If your student is currently having difficulty in school, to what do you attribute this difficulty?

4. Has your student ever been suspended or expelled from school? ( ) yes ( ) no

If yes, describe the circumstances.

Great Bay Charter School

Section IV: Other Adult QUESTIONNAIRE

To be completed by a non-relative adult who knows and regularly works with the student. (teacher, coach, counselor, advisor, or school administrator, etc. of the student’s choice.)

Student Name:_____________________________________________________________________

Your Name:____________________________________ Position: ___________________________

Direct Phone Number: ___________________________ School: ___________________________

The student named above is a candidate for admission to the Great Bay Charter School. We appreciate your honest responses to help us to determine if he/she is a good match for our program. Thank you in advance for your assistance.

Please circle the number corresponding to your agreement with the following statements:

| | |Strongly |Somewhat |Neutral |Somewhat Agree |Strongly Agree |

| | |Disagree |Disagree | | | |

| | | | | | | |

|1 |This student regularly works well with peers. |1 |2 |3 |4 |5 |

|2 |This student regularly works well with adults. |1 |2 |3 |4 |5 |

|3 |This student has demonstrated self-advocacy. |1 |2 |3 |4 |5 |

|4 |This student has demonstrated him/herself to be a positive |1 |2 |3 |4 |5 |

| |contributor to the school community. | | | | | |

|5 |This student has the potential to benefit from a project-based |1 |2 |3 |4 |5 |

| |learning environment. | | | | | |

|6 |This student regularly gives his/her best effort. |1 |2 |3 |4 |5 |

|7 |This student attends school regularly. |1 |2 |3 |4 |5 |

|8 |I recommend this student for admission to the Great Bay Charter |1 |2 |3 |4 |5 |

| |School. | | | | | |

On the back of this, or on a separate piece of paper, please describe the characteristics of this student which lead you to believe he/she will be successful at the Great Bay Charter School.

Signature_________________________________________________ Date ______/______/______

Great Bay Charter School

30 Linden Street

Exeter, NH 03833

603-775-8638

Fax 603-775-8528

RECORDS RELEASE FORM

STUDENT’S NAME:_____________________________ DATE OF BIRTH:_____________________

This release form enables Great Bay Charter School to receive your son’s/daughter’s records from the following institutions:

NAME OF INSTITUTION ADDRESS ZIP

1. ____________________________________________________________________

2. ____________________________________________________________________

I give the representatives of the Great Bay Charter School my permission to seek additional information related to grades and /or disciplinary records from the schools identified above. I will provide a copy of my students most current IEP or 504 along with my Intention to enroll received with the acceptance letter; alternatively, I give the school my permission to seek this information from the school above.

_________________________________________________

Parent/Guardian Date

Student must sign if over 18 year of age:______________________________________________

Great Bay Charter School

2021-2022 Application Worksheet

(This sheet does not need to be included in the application materials)

Student Name: __________________________________________

|( ) |Sections, I, II, III complete |

|( ) |Section IV ( ) Included |

| | ( ) To be sent by:_____________________________ |

|( ) |Copy of current IEP or 504 Plan enclosed (optional) |

| | |

|( ) |Records Release form signed and enclosed |

| | |

|( ) |Disclosure Statement signed and enclosed |

|( ) |Deliver, Mail, Fax or Email to one of the following: |

| | |

| |Great Bay Charter School |

| |30 Linden Street |

| |Exeter, NH 03833 |

| | |

| |Email to: info@ |

| | |

| |Fax to: 603-775-8528 |

|( ) |Deadline for Lottery: Received by Friday, April 16, 2021 at 3:30 PM |

| | |

|( ) |Student shadow date: ___________________________ |

| | |

|( ) |Interview scheduled by Great Bay Charter School: _________________________ |

| | |

|( ) |Notification received |

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