2001 Governor's Scholars Program - Forsyth County Schools



2021 U.S. Presidential ScholarGeorgia Department of EducationStudent Nomination Application-ACADEMICSDIRECTIONS: All information on this form must be completed on a computer. Handwritten applications won’t be accepted. No exceptions.SCHOOL INFORMATIONName of School System, Private School or Homeschool FORMTEXT ?????Name of High School and CEEB code FORMTEXT ?????School Phone( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????School Address (Street/Route/Post Office Box) FORMTEXT ?????City FORMTEXT ?????County FORMTEXT ?????Zip FORMTEXT ?????Congressional District FORMTEXT ??APPLICANT INFORMATIONStudent’s First Name FORMTEXT ?????Student’s Middle Name FORMTEXT ?????Student’s Last Name FORMTEXT ?????Student’s Preferred Name FORMTEXT ??????????Email FORMTEXT ?????Home Address (Street/Route/Post Office Box) FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????Home Phone( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Birth Date (MM/DD/YY) FORMTEXT ?????Age FORMTEXT ?????Grade FORMTEXT ?????Gender FORMCHECKBOX Male FORMCHECKBOX FemalePARENT/GUARDIAN INFORMATIONParent 1/ Legal Name FORMTEXT ?????Relationship FORMTEXT ?????Home Address (Street/Route/Post Office Box) (Write SAME if same address) FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????Business Phone ( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Cell Phone( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email FORMTEXT ?????Parent 2/ Legal Guardian Name FORMTEXT ?????Relationship FORMTEXT ?????Business Phone ( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Cell Phone ( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email FORMTEXT ?????ALL CRITERIA MUST BE MET AND ALL REQUIREMENTS MUST BE VERIFIED AS INDICATED IN ORDER TO BE NOMINATED FOR U.S. PRESIDENTIAL SCHOLAR DIRECTIONS: All information on this form must be completed on a computer. Handwritten applications won’t be accepted. No exceptions.PROGRAM REQUIREMENTSSIGNATURE VERIFICATION FOR SECTIONS A-D ARE REQUIREDStudent’s Name FORMTEXT ?????School System/Private School/Homeschool FORMTEXT ?????AWill student graduate between January-June 2021? Yes or No: FORMTEXT ?????Principal’s signature:________________________________BStudent’s total SAT score: FORMTEXT ????Reading and Writing Section FORMTEXT ????Math Section FORMTEXT ????And/Or student’s total ACT: FORMTEXT ??Are student’s scores marked public or private: FORMTEXT ?????Principal’s signature:_______________________________CStudent’s cumulative GPA: FORMTEXT ?????What is your rank in scholastic standing of your class? FORMCHECKBOX Upper 1% FORMCHECKBOX Upper 5 % FORMCHECKBOX Upper 10 % FORMCHECKBOX Upper 15% FORMCHECKBOX Upper 25 % Principal’s signature: ______________________________ DChoose one of the following: FORMCHECKBOX U.S. Citizen FORMCHECKBOX Legal permanent resident FORMCHECKBOX Non-CitizenSchool level coordinator’s signature:___________________________Answer the questions below. Text boxes will expand as you type.What makes you an outstanding scholar? (150-250 words) FORMTEXT ?????Did you have special challenges or hurdles while still achieving high academic success?(125-250 words) FORMTEXT ?????List academic achievements: FORMTEXT ?????In grades 9-12, list leadership positions held in school sponsored organizations (e.g., clubs, school publications, special school events). Include dates of involvement/service. Text boxes will expand as you anization & position 1. FORMTEXT ?????Dates of involvement/service FORMTEXT ?????Organization & position 2. FORMTEXT ?????Dates of involvement/service FORMTEXT ?????In grades 9-12, list evidence of involvement in school and community (e.g., civic organizations, community groups, charities, etc.). Include dates of involvement/service. Note: This does not include paid positions. Text boxes will expand as you anization & activity 1. FORMTEXT ?????Dates of involvement/service FORMTEXT ?????Organization & activity 2. FORMTEXT ?????Dates of involvement/service FORMTEXT ?????Organization & activity 3. FORMTEXT ?????Dates of involvement/service FORMTEXT ?????DIRECTIONS: All information on this form must be completed on a computer. Handwritten applications won’t be accepted. No exceptions.If your parents or guardians are willing for you to go to Washington, D.C., to receive the Presidential Scholar Medallion, please have them sign below:Date (MM/DD/YY) FORMTEXT ?????Student’s Name FORMTEXT ?????Student’s Signature (REQUIRED) Date (MM/DD/YY) FORMTEXT ?????Parent’s/Guardian’s Name FORMTEXT ?????Parent’s/Guardian’s Signature (REQUIRED)Date (MM/DD/YY) FORMTEXT ?????Principal’s Name FORMTEXT ?????Principal’s Signature (REQUIRED)Date (MM/DD/YY) FORMTEXT ?????School Level Coordinator’s Name FORMTEXT ?????Email FORMTEXT ?????School Level Coordinator’s Signature (REQUIRED)Date (MM/DD/YY) FORMTEXT ?????Superintendent’s/Headmaster’s Name FORMTEXT ?????Superintendent’s/Headmaster’s Signature (REQUIRED)I support the application of this student for the 2021 Presidential Scholar Program and I have confirmed ALL verifications for accuracy and required signatures.Date (MM/DD/YY) FORMTEXT ?????System Coordinator’s Name FORMTEXT ?????System Coordinator’s Signature (REQUIRED)Coordinator’s Phone Number( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email FORMTEXT ?????Instructions for coordinator:This document is for local district/private school/homeschool use only. The application information for the students you nominate to represent your local district/private school/homeschool will need to be submitted to the electronic application platform. The electronic application for the nominated students will be due to GaDOE on or before 5 p.m. on November 6, 2020. Local deadlines will likely be different.It is the responsibility of the sender to ensure and verify that the application information is received electronically by the deadline.Emailed, faxed or mailed applications will not be accepted.PLEASE RETAIN FOR YOUR RECORDS ONE COPY OF EACH COMPLETED STUDENT APPLICATION. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download