Massachusetts Department of Elementary and Secondary Education
U.S. Presidential Scholars Program 2016-2017
STUDENT INFORMATION FORM
Student Information:
Last Name: ______First Name: ______MI: ______
Mailing Address: ______
City: ______State: ______Zip Code: ______
Please complete the appropriate Student Nomination Section(s) as indicated below
Section 1: To be completed for General Student Nominations Only
Section 2: To be completed for both General and Career & Technical Education Student Nominations
Section 3: To be completed for Career and Technical Education Student Nominations Only
SECTION 1
(Complete for General Student Nomination Only)
Involvement and Service (School and Community)
List the school activities in which this nominee has participated during grades 9-12. Please indicate by placing an "x" in the appropriate grade level(s). Limit your response to the space provided in the table - one entry per line. Attach addendum in the same format if needed.
(Do not replace this format with a résumé. It will NOT be considered.)
Student School Activities / Grade Level9 / 10 / 11 / 12
EXAMPLE: Band / X
Non-paid Community Service
Limit your response to the space provided in the table - one entry per line. Attach addendum in the same format if needed.
(Do not replace this format with a résumé. It will NOT be considered.)
Community Activities / Hours per Week per Grade9 / 10 / 11 / 12
EXAMPLE: Hospital Volunteer / 5 / 10 / 15 / 20
SECTION 2
(Complete for General and CTE Student Nominations)
Academic Achievement(s)
List academic achievements, special recognition, awards, and honors received during grades 9-12. Please indicate by placing an "x" in the appropriate grade level(s). Only list commendations not previously listed. Limit your response to the space provided - one entry per line. Attach addendum in the same format if needed.
(Do not replace this format with a résumé. It will NOT be considered.)
Achievements/Awards/Honors / Grade9 / 10 / 11 / 12
EXAMPLE: National Merit Scholar / X
Academic Standing
STUDENT’S NAME: ______
Please indicate below:
· Nominee's GPA ______on an ______Unweighted Scale
· % average ______
· Class rank ______out of ______(indicate by exact position: ex. 3 out of 150)
· SAT Scores: Critical Reading: ______Math: ______Writing: ______
· ACT Scores: ______
This Box to be completed for CTE Student Nominations only:Grade point average in Student’s CTE Program ______(Min. 3.25)
MCAS Scores: ELA ______Math ______Science ______
The nominee will graduate from:
School: ______on or about Date: ______
Character and Leadership: Please tell us about this student’s character and leadership. What about this student makes him or her stand out as having outstanding scholarship and promise of future success?
Obstacles overcome: What challenges are you aware of that this student has overcome while still maintaining integrity and academic success?
Please limit responses to two pages.
Please include a writing sample from each nominee. Each student writing sample should be font size 11 or larger and limited to 1 -2 pages. The student writing sample may be a previously completed classroom assignment or other writing sample. If handwritten, please check for legibility.
SECTION 3:
(Complete for CTE Student Nominations only)
Application Pool
Students will represent the multiple sectors that are viewed as the pillars of our nation’s economic growth (i.e., the five sectors identified in the President’s Blueprint: Healthcare, IT, Advanced Manufacturing, STEM, and Transportation), as well as the socioeconomic characteristics of our nation’s high school graduates.
Technical Competence
Students will demonstrate mastery of technical skills demanded by industry.
Technical Competence as demonstrated by one or more of the following:
§ Completion of a work-based or community-based learning experience (Note: The term ‘work-based learning’ means a program of structured work experiences (such as cooperative education, internships, clinical experience, on-the-job training, and apprenticeships), that is coordinated with classroom-based learning and designed to enable students to apply career and technical education skills and knowledge in a work environment).
§ Placing a medal in State and/or national Career and Technical Student Organization (CTSO) skills competition in his/her career area.
§ Earning an industry-recognized certification/credential.[1]
List technical competence achievements, special recognition, awards, and honors received during grades 9-12. Please indicate by placing an "x" in the appropriate grade level(s). Only list commendations not previously listed. Limit your response to the space provided - one entry per line. Attach addendum in the same format if needed.
(Do not replace this format with a résumé. It will NOT be considered.)
Technical Competence / Grade9 / 10 / 11 / 12
EXAMPLE: Certified Nursing Certification / X
Employability Skills
Student will demonstrate such professional skills as teamwork, decision-making, and problem solving.
· Employability Skills as demonstrated by one or more of the following:
§ Completion of a work-based learning experience that is an integral part of the curriculum of the program of study.
§ Leadership role in a Career and Technical Student Organization (CTSO) at local, state, or national level.
§ Completion of a community service project or other student leadership activity in his/her career and technical education program.
List employability skills the student participated in during grades 9-12. Please indicate by placing an "x" in the appropriate grade level(s). Only list commendations not previously listed. Limit your response to the space provided - one entry per line. Attach addendum in the same format if needed.
(Do not replace this format with a résumé. It will NOT be considered.)
Employability Skills / Grade9 / 10 / 11 / 12
EXAMPLE: Participation in Cooperative Education / X
Ingenuity and Creativity
Students will have solved a real-world problem through the application of technical skills they developed in their technical program.
Ingenuity/Creativity/Problem Solving as demonstrated by one or more of the following:
§ Solution to a real-world problem (e.g., developed electric car that goes faster than any before).
§ Development of a new product/good or service (e.g., development of an app).
List ingenuity, creativity, problem solving demonstrated by the student during grades 9-12. Please indicate by placing an "x" in the appropriate grade level(s). Only list commendations not previously listed. Limit your response to the space provided - one entry per line. Attach addendum in the same format if needed.
(Do not replace this format with a résumé. It will NOT be considered.)
Ingenuity/Problem Solving / Grade9 / 10 / 11 / 12
EXAMPLE: Designed a manufacturing component / X
2
[1] The term ‘certification’ means a certificate from industry and awarded by a certification body based on an individual’s demonstration, through an examination process, that he or she has acquired the designated knowledge, skills, and abilities to perform a specific job.