5170 Fayetteville Road - Lumberton, North Carolina 28360

Robeson Early CollegeHigh School

APPLICATION FOR ADMISSION

Name of Student: ______

First Middle Last

Student Number: ______Current School: ______

Sex: Male_____ Female_____ Birthday:Month_____ Day_____Year ______

Mailing Address:______City:______Zip: ______

Physical Address:______City:______Zip:______

Home Telephone Number:______

Ethnicity/Race: (Please check one)

American Indian/ Alaska Native____ Asian/Pacific Islander____ Black______

Hispanic____ White____ Multiracial____ Other:____(Please specify) ______

The student lives with: Both parents____Father____ Mother____

Grandparent______Guardian______Step-Parent _____

If Guardian, who is the Legal Guardian of student? ______

Parent / Guardian Information: Nameof Parent (s)/Guardian: Last Name: ______First ______

Mailing Address (if different from student):______

Parent Work Number:______Parent Cell Number______

Mother’s Educational Level(circle one): Some high school/ High School Graduate/ Some college/ Associate Degree Graduate/ Bachelor’s Degree Graduate/ Master’s Degree/

Father’s Educational Level:(circle one): Some high school/ High School Graduate/ Some college/ Associate Degree Graduate/ Bachelor’s Degree Graduate/ Master’s Degree/

INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED FOR ADMISSION!

APPLICATION DEADINE IS THURSDAY, MARCH 9, 2017

STUDENT PROFILE

NAME: ______

We are interested in learning more about you, your interests and your personal academic goals.

THIS IS NOT ATEST.THERE ARE NO RIGHT OR WRONG ANSWERS!Please answer the following questions listed below and tell us about yourself.This is an opportunity to express in your own words, who you are and what is important to you.

Write three words that best describe you.

1. ______2. ______3. ______

Which academic subjects interest you the most? Why?

______

______What do you believe are your academic weaknesses? Why? How do you overcome these weaknesses?

______

Why do you want to attend Robeson Early College High School?

______

*********************************************************************************************

Please rate yourself in the following areas compared to students in your grade:

OutstandingGood AverageBelow Average

Leadership
Self-confidence
Independence
Trustworthy
Disciplined
Self-starter
Team Player

PARENT STATEMENT

Name of Parent completing this form: ______

Are you the Legal Guardian?: ______

What are your expectations for your child’s education?

______

Please comment on your child’s academic strengths and weaknesses.

______

What do you see as the advantage of an EarlyCollegeHigh School for your child’s high school career?

______

Please comment on any personal setbacks, difficulties and / or medical issues that your child has experienced. ______

Your input regarding your child is important to us. If there is any additional information you would like us to know about your child, please state it at this time.

______

Parent/ Guardian Signature: ______Date: ______

COUNSELOR FORM

Applicant Name: ______Student Number: ______

Applicant Social Security Number: ______

Traditional high school applicant will be assigned to for 2017-2018 school year: ______

The following information will be utilized to assist in determining student enrollment:

1. Is this student AIG? ____No ____Yes If yes, which area(s): Math_____ Reading____

2. Does this student receive ESL servicesYes______No ______

3. Is this student EC?No _____ Yes____ If yes, please provide below the area of exceptionality:

______

4. Does the student have a 504? No ___ Yes____ If yes, what is condition? ______

4. Have there been discipline referrals?No ____ Yes_____ If yes, please explain below:

______

Have there been any out of school suspensions?No ____ Yes ______If yes, please explain below:

______

Attendance: Number of Days Absent ______2015-2016 Number of Days Absent ______2016-2017

****PLEASE ATTACH COPY OF LAST REPORT CARD & ATTENDANCE SUMMARY

Please explain why this student is a good candidate for Robeson Early College High School. ______

______

TESTING INFORMATION

7th Grade EOG Scores:Math______Level ______

Reading ______Level ______

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

Signature: ______Date: ______

Name printed:______Title: ______

Robeson Early College High School

5170 Fayetteville Road - Lumberton, North Carolina 28360

RECOMMENDATION

Recommender: Early College High School has a rigorous college preparatory program curriculum. With this in mind, please complete the form below. This form will remain confidential. We sincerely appreciate your cooperation and candor. This form must be returned in a sealed envelope with the recommender’s signature on the back.RECOMMENDATION SHOULD BE RETURNED TO STUDENT TO BE INCLUDED IN THEIR APPLICATION PACKET. ONLY RECOMMENDATION FORMS SHOULD BE SUBMITTED. LETTERS WILL NOT BE ACCEPTED.

COMPLETED APPLICATION PACKET IS RETURNED TO SCHOOL COUNSELOR.

(Please Print)

NAME OF APPLICANT: ______Student ID # ______

Current School: ______

Recommendation By: ______Position: ______

How long have you known the student? ______

Academic Qualities

Below Average Average Good Excellent

Study Habits
Attention Span
Ability To Work Independently
Ability to Organize
Motivation
Intellectual Curiosity

Personal Qualities

Below Average Average Good Excellent

Academic Commitment
Creativity
Self-Confidence
Leadership Potential
Reaction to Criticism
Concern for Others
Personal Conduct
Personal Integrity
Ability to Act Independently
Ability to Work Cooperatively with Others
Level of Maturity
Sense of Humor

Please provide examples of this student’s academic /personal qualities that may help us in our decision making process: ______

______

Robeson Early College High School

5170 Fayetteville Road - Lumberton, North Carolina 28360

RECOMMENDATION

Recommender: Early College High School has a rigorous college preparatory program curriculum. With this in mind, please complete the form below. This form will remain confidential. We sincerely appreciate your cooperation and candor. This form must be returned in a sealed envelope with the recommender’s signature on the back. RECOMMENDATION SHOULD BE RETURNED TO STUDENT TO BE INCLUDED IN THEIR APPLICATION PACKET. ONLY RECOMMENDATION FORMS SHOULD BE SUBMITTED. LETTERS WILL NOT BE ACCEPTED.

COMPLETED APPLICATION PACKET IS RETURNED TO SCHOOL COUNSELOR.

(Please Print)

NAME OF APPLICANT: ______Student ID # ______

Current School: ______

Recommendation By: ______Position: ______

How long have you known the student? ______

Academic Qualities

Below Average Average Good Excellent

Study Habits
Attention Span
Ability To Work Independently
Ability to Organize
Motivation
Intellectual Curiosity

Personal Qualities

Below Average Average Good Excellent

Please provide examples of this student’s academic /personal qualities that may help us in our decision making process: ______

______

Read Carefully!

A copy of the Early College High School Application is available on the website at .
Use pen (black or blue only)
Pictures are required and must fit the square on application page.
All information requested is required!
Double check your application to make sure it is COMPLETE. Incomplete applications will not be reviewed.
Each recommendation should be placed in a white business envelope, sealed with the name of the recommender written across the seal.Letters will not be accepted. RECOMMENDATIONS SHOULD BE RETURNED TO STUDENTS AND RETURNED TO SCHOOL COUNSELOR WITH APPLICATION PACKET.
Make sure your parent signature is on page 3.
The School Counselor or principal designee is required to complete the Counselor Form, verify that all requested documents are attached and each application is completed. Counselor Form will be completed AFTER application is turned into the School Counselor.
It is preferred that all applications received from middle school be brought by the school counselor at one time.
Application deadline is Thursday, March 9, 2017. School Counselors may give an earlier date to allow time to process individual school applications.
Due to the large number of applications received, everyone will not receive an interview. And, not everyone who receives an interview will be accepted.

AFTER YOU SUBMIT YOUR APPLICATION

Students who are selected for an interview will be contacted by mid-April.Interviews will be conducted and students who are accepted students will be notified by mail before June 15.
Early College High School will begin the first week of August.

Questions ??? Please contact your School Counselor or

Early College High School at 737-5232.