PENDER EARLY COLLEGE HIGH SCHOOL



APPLICATION FOR ADMISSION

Demographic Data: (This information will be used for State/Local Reports)

Student Name: _________________________________________________________________

Last First Middle

Current School: _________________________________________________________________

Sex: __ Male __ Female- Birthdate ____/_____/_____ State of Birthplace: _________________

Month Day Year

Mailing Address: ________________________________City: ____________Zip_____________

Home Address: _________________________________City: ____________Zip_____________

Student Email Address: ___________________________________________________________

Home Telephone Number: _______________Student Cell Phone Number: ___________________

Ethnicity/Race:

_______ American Indian_______Alaskan Native ________Asian/Pacific Islander _______Black

_______ Hispanic ________ White ____________Multi-Racial ______ Other

Parent/Guardian Information:

Mother’s Name: __________________________ Father’s Name: _________________________

Guardian (if applicable): ______________________ Relationship to Student: _______________

Mailing Address (if different from student): ___________________________________________

Parent(s) Work Number: __________________ Parent(s) Cell Phone Number: _______________

Place of Employment: (M) ___________________________ (F) ___________________________

Parent(s) Email Address: __________________________________________________________

Parent(s) Highest Educational Level Attained (Place an “M” for Mother/”F” for Father) even if the parent(s) are not in the home:

_____Did not graduate high school ____High school graduate____ Some college/Certificate

_____Completed Associate Degree ____Completed Bachelor’s Degree

_____Completed Master’s Degree _____Completed Doctoral Degree

Applications must be fully completed in order to be reviewed.

Application deadline is February 26, 2016 and should be submitted to your counselor.

Date application submitted to your school counselor_______________________

Pitt COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOL Admission Essay

The Pitt County Schools Early College High School is a rigorous program designed to provide students with an opportunity to earn a High School Diploma and an Associate degree at no cost to the student. It requires a strong work ethic and a commitment to success. In 500 words or less, in your own handwriting, explain what you think it will take for you to successfully meet the challenges in completing this program. Provide examples of your work ethic from past experiences in school.

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Student Statement

Sign below if you agree to the following:

• I understand that my commitment to Pitt County Schools Early College High School is for at least one full academic year.

• I expect to complete a two-year degree program while at Pitt County Schools Early College High School.

• I am able to complete the Future Ready Core Course of Study.

• I will maintain high academic and behavior standards.

• I understand that there are no athletic or ROTC programs and limited clubs at Pitt County Schools Early College High School.

• I understand that Pitt County Schools Early College High School will operate on the Pitt Community College school calendar, NOT the calendar of Pitt County Schools.

I have read these statements and I agree to abide by them as well as the rules and policies of Pitt County Schools Early College High School

Student Signature: ____________________________________ Date: _____________________

Parent/Guardian Statement

(To be completed by parent/guardian)

Students succeed best when the school, the parent/guardian, and the student work together. Please sign below if you agree to the following expectations as parent/guardian:

• I understand that my child’s commitment to Pitt County Schools Early College High School is for at least one full academic year.

• I agree to make every effort to ensure my child is in school every day.

• I agree to attend and support school functions.

• I understand that my child must be able to complete the Future Ready Core Course of Study.

• I will encourage and expect high academic and behavior standards from my child.

• I understand that there are no athletic or ROTC programs and limited student clubs.

• I understand that Pitt County Schools Early College High School will operate on the Pitt Community College calendar, not the Pitt County Schools calendar.

• I agree to encourage my child to abide by the rules and policies of Pitt County Schools Early College High School

Name of Parent/Guardian and Signature: Date: __________________________________________________ _________________________

By my signature below, I agree to the following:

I give permission for the Child Nutrition Director in the school district to confirm the student is currently eligible for free or reduced price meals at school, or for the principal or guidance counselor to certify that the student is eligible for Need Based assistance.

Signature of Parent or Guardian: ________________________ Date: _____________________

TO BE COMPLETED BY SCHOOL COUNSELOR OR PRINCIPAL DESIGNEE ONLY

Both the student and parent sections should be completed BEFORE the counselor or principal designee completes this section.

Applications must be fully completed in order to be reviewed.

Student Name: __________________________________ PowerSchool Number ____________________

Person completing form: ___________________________ Title: _________________________________

Please complete the following information about the applicant.

Please check one:

1. Exceptional Children: _______ Yes ________ No

If yes, please state area(s) of exceptionality __________________________________________

If this student is EC, what course of study is he/she pursuing? Please check one:

______ Future-Ready Core ______ Future-Ready Occupational

504 Plan: Yes________ No________ Accommodations: ________________________________

Is this student AIG? _____ Yes ______ No

2. Does this student receive ESL Services? _______ Yes ______ No

3. Discipline: Number of Incidents: 7th Grade_________ 8th Grade_________

Please explain any extenuating circumstances__________________________________________

______________________________________________________________________________

______________________________________________________________________________

How many absences did this student have in 7th grade? _______Currently in 8th Grade________ Please explain any extenuating circumstances__________________________________________

____________________________________________________________________________________________________________________________________________________________

4. Testing Information: Please attach score reports or complete the section below.

7th Grade EOG Scores: Math Percentile __________ Level ________

Reading Percentile __________ Level ________

______________________________________________________________________________

The Pitt County Schools Early College school counselor will follow up with you in June to obtain 8th grade EOG scores (if unavailable at time of application).

I verify that the information listed is true and accurate to the best of my ability.

Signature: ______________________________________________ Date: _________________________

Pitt County Schools Early College High School Teacher or Counselor Recommendation

(Confidential Information-Please return to student in sealed envelope)

Student Name: ________________________________PowerSchool Number _______________________

Current School: _____________________________________ Grade Level: ________________________

Recommendation completed by: (Please print) ________________________________________________

The above student is applying for admission to Pitt County Schools Early College High School, which is located on the main campus of Pitt Community College. This recommendation is for the 2016-2017 school year. Students enrolled in this program simultaneously complete their high school education and an Associate Degree or a two-year degree program. Your responses will be valuable in helping the Review Committee to identify which students will benefit and succeed in this program. Without this recommendation form, a student’s application is incomplete and will not be reviewed for admission. If you have any questions please contact Principal Wynn Whittington at wynn.whittington@pitt.k12.nc.us or Counselor-Ms. Bernetta Bradley at bradleb@pitt.k12.nc.us at Pitt County Schools Early College High School.

Please check any characteristics that apply to this student:

___ bright/intelligent ____ shows leadership capabilities

___ demonstrates artistic abilities ____ seeks academic challenges

___ participates in class discussion ____ eager to join the adult world

___ desires more freedom or independence ____ shows little/no interest in learning

___ demonstrates consistent academic effort ____ consistent discipline problems

___ performs to potential ____ needs help with career goals

___ needs personal attention and encouragement ____ capable of performing at higher level

___ follows through on homework assignments retained in grades_____________________

___ disassociates from middle school activities

___ experiences struggles common to today’s teens (divorce, loneliness, peer pressure, etc.)

Evaluate the student’s current performance by circling one in each category.

Please comment.

Attendance: Excellent Good Fair Poor

Comment: ____________________________________________________________________________

Classroom Attitude: Excellent Good Fair Poor

Comment: ____________________________________________________________________________

Class Work: Excellent Good Fair Poor

Comment: ____________________________________________________________________________

Potential for success in college environment (with support):

Excellent Good Fair Poor

Comment: ____________________________________________________________________________

Additional comments may be written on the back of this form.

Signature: _______________________Telephone Number: ________________ Date: ________________

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