Westwind Academy Charter High School
Hillcrest Prep
Application
(Arizona Residents, Out-of-State & International Students)
School Year 2016-2017
Date: _____________________
Deposit Received: ________ (Staff Initials) Boarding: ___Yes ___No
Student Information (Please print neatly)
Legal Name _____________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents) First/Given Middle (Complete) Jr. etc
Preferred name, (Nickname) _________________________ Birth Date _______________________ Male_____ Female_____ Age_______ mm/dd/yyyy
Birth Information: _______________________________________ Social Security Number (or Passport #) ________ ____________
City /Town State/Province Country
Current Mailing Address: _____________________________________________________________________________________________________________
Number & Street Apartment #
_______________________________________________________________________________________________________________________________________
City/Town County/Parish State/Province Country Zip/Postal Code
Telephone Number: Home (______) _____________________Cell (______) ______________________Work (______) ___________________
Student’s Email Address: ____________________________________
Parents’ Email Address: (a)_________________________________________(b) __________________________________________________
Family
Student Lives With: □Both Parents □Mother □Father □Legal Guardian □Relative □Other
If parents live separately, who will receive mailings? □Both Parents □ Mother □ Father □Guardian □ Relative □Other
Parent 1:□Mother □Father □Legal Guardian
□Contact in case of emergency □ Authorized to Release
__________________________________________________
Last/Family/Sur First/Given Middle
________________________________________________
Home address ( if different from student’s )
__________________________________________________
Number & Street Apartment #
__________________________________________________
City/Town State/Province Country
Telephone:
Home (______) __________________________
Cell (______) ___________________________
Work (______) __________________________
Occupation _______________________________________
Employer _________________________________________
Parent 2: □Mother □Father □Legal Guardian □Contact in case of emergency □ Authorized to Release
__________________________________________________
Last/Family/Sur First/Given Middle
________________________________________________
Home address ( if different from student’s)
__________________________________________________
Number & Street Apartment #
_________________________________________________
City/Town State/Province Country
Telephone:
Home (______) __________________________
Cell (______) ___________________________
Work (______) __________________________
Occupation _______________________________________
Employer__________________________________________
Emergency Contact Information
Contact 1 (In addition to parent listed above)
__________________________________________________
Last/Family/Sur First/Given Middle
Relationship to Student______________________________
Telephone:
Home (______) __________________________
Cell (______) ___________________________
Work (______) __________________________
Is this person authorized to release student? □Yes □ No
Contact 2(In addition to parent listed above)
________________________________________________
Last/Family/Sur First/Given Middle
Relationship to Student______________________________
Telephone:
Home (______) __________________________
Cell (______) ___________________________
Work (______) __________________________
Is this person authorized to release student? □Yes □ No
Academic Information
Graduation Date: ____________ Core GPA: ________ SAT/ACT Score: _______ (N/A if not taken)
Enrolled in NCAA Clearinghouse ρYes ρNo
____________________________ ____________________ ____________ _____ ______/______/______
Current or Last School Attended District City State Last Date of Attendance
Is your student on track to graduate with his/her class (high school)? ρYes ρNo (Please submit an unofficial transcript along with this enrollment packet.) If no, how many credits have been earned to date? _______________
Has your student ever been found responsible for a disciplinary violation at any educational institution you have attended, whether related to academic misconduct or behavioral misconduct, which resulted in your probation, suspension, removal, dismissal, or expulsion from the school? (Please note that we verify this information with previously attended schools.)
ρYes ρNo
If yes, explain: ______________________________________________________________________________________________________
Has your student ever been out of school for: ρ1-4 week’s ρOne semester ρOne year ρTwo years?
If yes, explain the reason for their extended absence: ______________________________________________________________________________________________________
Medical Information
Please Note: There is not a school nurse on campus.
Does your student have any medical conditions the school should be aware of? ρYes ρNo If yes, please explain.
Are there any physical or mental health conditions or concerns that would place your student at risk? ρYes ρNo
Please give a brief explanation: _____________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Is your student taking any medication? ρYes ρNo
If yes, please list and explain_______________________________________________________________________________________________
_______________________________________________________________________________________________________________________
If yes, will these medications be taken during school hours? ρYes ρNo
I authorize the school representative to securely store my student’s prescription medication that he/she is required to take during the school day. I also authorize the school representative to disperse the medication to my student, according to the instructions. If my student’s medication changes, I will notify the school immediately. I understand that students are not to keep their own prescription medications. If my student requires an inhaler for asthma, I will notify the school of this prior to my student having the inhaler on campus and in his/her possession.
Parent Signature_____________________________________________ Date ____________________
Authorization to Transport & Insurance Information
ρYes ρNo My student has medical insurance. (Student athletes in the post grad program and International students are required to have medical insurance. If you do not have medical insurance, you will need to purchase before coming to Hillcrest. International students should go to to purchase insurance for their duration in the United States. Proof of insurance is required.)
Medical Insurance Carrier ____________________________________Policy Number___________________________
Name of Insured ______________________________ I.D. Number ____________________________
Physician Name_______________________ Phone___________________ Hospital Preference___________________
I hereby give permission for my student listed above to be transported by Hillcrest Academy for the purpose of school related activities.
I also give agents of Hillcrest permission to authorize any emergency medical treatment that may become necessary while my student is in school in the event that I cannot be reached. Furthermore, I realize that any expenses related to medical attention given are my responsibility.
In case of injury or sudden illness, I hereby give authority to any hospital or doctor to render immediate aid as might be required at the time of his/her health and safety. I understand that the expense of this service will be my responsibility.
Parent/Guardian Signature__________________________________________________ Date __________________
Student Personal Information Release
The Hillcrest Prep Post Graduate and International program occasionally publishes the first name and/or pictures of students involved in school activities on our web site and other forms of media. This form gives you the option to choose whether or not you would like your student’s first name and/or pictures featuring your student, published on our web site and other media. (Please note, however, student directory information will be provided to law enforcement officers or the court if requested or in case of an emergency.)
IMPORTANT: GAMES ARE UPLOADED TO YOUTUBE. THIS IS DONE AUTOMATICALLY. THEREFORE, IF YOU DO NOT WANT YOUR STUDENT ATHLETE’S IMAGE TO APPEAR ON YOUTUBE, HE/SHE WILL NOT BE ABLE TO PLAY IN ANY GAMES OR TOURNAMENTS.
I Do Not Want Hillcrest Prep, to publish the following information for my student (check all that apply):
ο Publish student's name (first name only) on the school’s web site, which is available on the internet:
(Example: John won 1st place at the State Science Fair; Amy demonstrates volcanic eruptions in Science class.)
ο Publish student's photo on the school’s web site.
ο Publish student's photo/ and full name in Hillcrest Academy Publications: i.e.; school newsletters, local newspaper articles, etc.
ο Allow my student to appear on Television.
ο Publish student's photo (no names) in school advertising venues. i.e.; brochures, newspapers ads, etc.
ο Release student’s name, address, and phone number to military recruiters
ο Release student’s name, address, and phone number to post secondary schools.
Demographics
Home Language Survey
This question is in compliance with A.R.S. 15-756. Identification of English Language Learners. Your response to the following question will be used to determine whether your student will be assessed for English language proficiency:
What is the primary language used in the home regardless of the language spoken? ________________________________________
Language most often used by the student
What is the language most often spoken by the student? ________________________________________________________
Language most often spoken by the student
What is the language that the student first acquired? ________________________________________________________
Language first acquired by the student
Are you proficient in any other languages? ___________________
Race and Ethnicity Data Collection
In accordance with federal guidance, a two-part question must be used to collect data about student race and ethnicity. The first part of the question is on ethnicity and the second is on race. The race question can have multiple values.
Part 1: Ethnicity
Is this student Hispanic or Latino? (Choose only one)
❑No, not Hispanic or Latino
❑Yes, Hispanic or Latino (A person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race.)
Part 2: Race
What is the student's race? (Regardless of how student answered the first question, choose one or more)
❑American Indian or Alaska Native (A person having origins in any of the original tribal peoples of North and South America, including Central America, and who maintains affiliation or community attachment.)
❑Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)
❑Black or African American (A person having origins in any of the black racial groups of Africa.)
❑Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
❑White (A person having origins in any of the original peoples of Europe, the Middle East or North Africa.)
Player Info & Stats
Position played in High School: ______________ AAU Team(s): _____________________________
Position played on AAU team: ______________ _____________________________
Height: ________ Average Points per Game: HS_____ AAU___ Average Assists: HS____AAU ___
Weight:________ Average Rebounds per Game: HS __ AAU __
Player Awards: _______________________________________________________________
_______________________________________________________________
Team Accomplishments: _______________________________________________________
________________________________________________________
Enrollment Policies
Hillcrest Prep will only accept transfer grades of C or above. Students who have a D or F in a class will have to retake the class for credit after transferring to Hillcrest Prep or petition their prior D’s for credit. Students whose GPA falls below a 2.0 will be put on academic probation and have one semester to increase his/her GPA above that level. Students who have been long term suspended or expelled from another school will not be allowed to enroll in Hillcrest Prep. If we receive notification of this after the student has enrolled, the student will be immediately withdrawn.
Post graduate and international students are expected to follow all the rules contained in the school’s Code of Conduct.
Enrollment Policies during a Semester (High School Students Only)
Please read the following policies and procedures and sign below to indicate you have read and understand them.
Student enrolling in Mid-Semester
Students transferring mid-semester must provide their transfer grades from their previous school in order for those grades to count toward the current semester classes. For students who do not enroll with transfer grades, the subsequent procedure will follow.
1. If the student enrolls two weeks or less into the semester, he/she will need to make up the work and continue with the rest of the class.
2. If the student enrolls between 2 and 11 weeks into the semester, he/she will be excused from whatever work he/she has missed, but then must pass the post test for the course with a 70% in order to receive credit.
3. If the student comes in after the 11th week, he/she will audit the class
(doing all the work), but he/she will receive no credit.
Students are not accepted for credit after February 1st each year.
Athletics
Please Note: Any student participating in a sport will be required to obtain a physical.
Post graduate student athletes participating in Hillcrest’s post graduate program are involved in more than just practice. They are required to participate in all aspects of the program, including but not limited to the following: SAT/ACT prep; academic and professional action planning; community service; strength training, speed, skill and endurance training; and video analysis of practice and games.
Authorized Signature
I certify that all information submitted in the admission process – including the application and any supporting materials is factually true, and honestly presented, and that these documents will become the property of Hillcrest Academy to which I am applying and will not be returned to me. I understand that my student may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, should the information I have certified be false.
______________________________________________________ ___________________________________________________
Parent Signature Date Student Signature Date
FERPA Waiver/Records Release: Please sign below to authorize the schools permission to release transcripts and unofficial test scores when requested from colleges and universities. This shall remain in affect while student is/or is not enrolled with Hillcrest Academy.
___________________________________________________ ______________
Parent Signature Date
Fee Schedule
A $5000 deposit is due upon enrollment in the program. This deposit becomes nonrefundable 10 days prior to the start of the school year. (For international students, $200 of the deposit is non-refundable due to I20 mailing fees, etc.) This is due to the staffing, facility and programming contractual agreements required to be completed prior to the arrival of students. Hillcrest Prep recognizes that sometimes families cannot pay the entire balance by August 1st. Prior approval for this arrangement is required. Players who do not pay in full before August 1 will be charged an additional fee of $50 per month until all funds are received, and will be sent home if payments are not made on time according to the written agreement that is issued. Fees are nonrefundable once school starts unless the player becomes catastrophically ill or injured, with documentation from a licensed medical professional. All fees for the year must be paid in full by December 15 or players will not be allowed to return for the second semester.
There are a limited number of scholarships available to students at Hillcrest Prep, whether they are students who are athletes or non-athletes. Students who receive a scholarship must demonstrate financial need and are expected to participate in work/study. Parents and players may request scholarship assistance; but scholarships are not official unless approved in writing by the Superintendent. Conversations with coaches or other staff members do not constitute scholarship authorization.
Student athletes who are not living at home with parents or guardians are required to stay in school assigned housing.
Fees for prep players include games, practices, group training, travel, uniforms, warm ups, backpacks, and classes. When applicable, room and board includes housing and three meals per day, as well as meals when traveling. Players are responsible for their own spending money. International student fees include educational expenses (college courses, teacher pay, tutoring during school hours) room and board and travel expenses for school outings.
Tuition & Program Fees: $20,000
Room & Board: $15,000
Students may have received some scholarship money which will affect the pricing above. Make sure to pay the amount on your tuition contract. The pricing above is our full tuition.
Tuition Agreement
Parents/Guardian: ___________________________________
Address: __________________________________________
___________________________________________
Phone Number: ______________________
Email address: _______________________
Name of Student: _________________________
Total amount due: ___________________
Deposit Due: _____________________
By signing this contract, the parent/guardian agrees to abide by the terms stated here, as well as those in the parent/student handbook and handbook for residential students if applicable. It is understood that not every possible circumstance can be listed in a handbook and that students will be held accountable for appropriate behavior. It is the school administration’s expectation that students use good judgment and make acceptable decisions. Furthermore, the student and parent/guardian understand and accept that the school administration will have the determination of acceptable or unacceptable behavior and subsequent consequences. Additionally, continued enrollment is based on payments being current.
If a student is dismissed or withdrawn from the school for any reason other than a serious medical condition that makes it impossible for the student to continue (as documented by a physician), tuition, room and board and program fees are forfeited. There is no refund.
Parent/Guardian Signature: ___________________________ Date: ____________
Student Signature: __________________________________ Date: ____________
-----------------------
FOR OFFICE USE ONLY
Grad Year: _________
SAIS ID __________________
Entry Date: __________
Entry Code ________
HC/MA _________
JD _________
DS/EC___________
Referred By:
Q'Friend Q'Sibling Q'Brochure/Flyer Q'Drive-By
Q'Student Q'Internet Q'School Q'Yellow Pages
Q'Other___________________/MA _________
JD _________
DS/EC___________
Referred By:
❑Friend ❑Sibling ❑Brochure/Flyer ❑Drive-By
❑Student ❑Internet ❑School ❑Yellow Pages
❑Other_________________________________
Inclusive Education Philosophy
Hillcrest Prep embraces the philosophy of full inclusion, believing that special education students can best be educated in the regular classroom. Our teachers accept responsibility for all students in their classroom and modify, accommodate and adjust teaching techniques and classroom activities to meet the unique learning abilities of all students. Special education staff supports the regular classroom teacher with this process. There are not two distinctly different types of students, e.g. “special” and “regular.” All students are individuals with their own unique set of physical, intellectual and psychological characteristics that influence their instructional needs. There are not two discrete sets of instructional methods – one set for “special” students and another for “regular” students. Individualized instructional programs are designed for each student.
Educational Background
Yes No My student has had special education testing or
Evaluations. Date of last evaluation: _________
Yes No My student has been enrolled in a Special Education
Program at another school.
Yes No My student currently has an IEP. Date of last IEP
meeting: ______________
Yes No My student has taken an English Language
Exam. If so, please indicate which one and
the score: __________________________
................
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