Sinagua Middle School MIT-e
CONTINUING APPLICATION FOR 7th and 8th GRADE: Print legibly in blue or black ink. Address all items. Incomplete applications will not be considered.
- ______2. ______
Legal Name (Last, First, Middle)Preferred Name
3. ___ Female ___ Male4. Date of Birth _____/_____/_____
5. Home Phone: ( ) ______
6. Address: ______
StreetCityStateZip Code
7. Parent / Legal Guardian:
______
Title (Mr/s. Dr.)Name (First, Middle Initial, Last)
______( )______
RelationshipContact Phone
______
Title (Mr/s. Dr.)Name (First, Middle Initial, Last)
______( )______
RelationshipContact Phone
8. Adult’s Email: ______
______
PROGRAM CONTINUANCE – PARENT’S REQUEST:
I want my student to continue in the MIT-e Program. ___ Yes___ No
Parent Signature: ______Date______
Please continue to answer the following questions.
P1. How reasonable are the expectations for student achievement at MIT-e?
___ Extremely reasonable
___ Very reasonable
___ Moderately reasonable
___ Slightly reasonable
___ Not at all reasonable
P2. How high are the expectations for students at MIT-e?
___ Extremely high
___ Very high
___ Moderately high
___ Slightly high
___Not at all high
P3. How could the student experience in MIT-e be improved?
______
P4. If requesting to continue with the program, please explain how you think the program has benefited your child and why you would like them to continue. (Attach additional pages if necessary.)
______
PROGRAM CONTINUANCE – STUDENT’S REQUEST:
I want to continue in the MIT-e Program. ___ Yes___ No
Student Signature: ______Date______
If yes, please continue with the questions.
S1. Grade entering: ____ 7th ___ 8th
S2. Teacher Recommendations given to (must be your current MIT-e teacher and your current Math teacher:
MIT-e Teacher:______
(Name of Teacher)
Math Teacher:______
(Name of Teacher)
Print legibly in blue or black ink. Questions below must be completed by the student.
S3. Describe what you have gained from your experience in MIT-e this year?
______
S4. What do you see as some of the strengths of the MIT-e program?
______
S5. How would you like to see the MIT-e program improved?
______
S6: In a 2 paragraph T3C:Describe ways that you benefit the MIT-e program and how you help your classmates. Use direct examples for evidence of previous group work in the MIT-e program. Type or write (blue or black ink) on a separate sheet of paper and attach to this application.
TEACHER EVALUATION OF APPLICANT:
Name of Applicant: (please print)
______
LastFirstMiddle
INFORMATION RELEASE: Complete this section before giving recommendation to the teacher.
Under the terms of the Family Educational Rights and Privacy Act, ___ I waive ___ I do not waive any rights of access to this recommendation.
Applicant’s Signature: ______Date:______
Parent/Legal Guardian Signature: ______Date: ______
Dear Teacher,
Please give us with your professional judgment as to the applicant’s request to continue MIT-e.
Please complete and sign this form. Please return this recommendation to current MIT-e teacher.
*** Recommendation forms must be returned by March 3, 2014 ***
___ Highly Recommended to Continue MIT-e
___ Recommend to Continue MIT-e
___ Not Recommended to Continue MIT-e
Consistently / Often / Sometimes / NeverRate the student’s work and study habits:
Demonstrates ability to stay focused / 5 / 3 / 1 / 0
Completion of assignments on time / 5 / 3 / 1 / 0
Produces high quality of work / 5 / 3 / 1 / 0
Demonstrates ability to work alone / 5 / 3 / 1 / 0
Demonstrates ability to work in groups / 5 / 3 / 1 / 0
Utilizes all forms of communication effectively / 5 / 3 / 1 / 0
Exhibits life skills such as responsibility and accountability / 5 / 3 / 1 / 0
Rate the student’s conduct and behavior in class:
Interacts with adults respectfully / 5 / 3 / 1 / 0
Follows class/school rules and procedures / 5 / 3 / 1 / 0
Applies effective use of collaboration and cooperation skills / 5 / 3 / 1 / 0
Thinks critically, creatively, independently and originally / 5 / 3 / 1 / 0
COMMENTS: Please provide any other information that you think would be important for us to know about this student:
______
______
______
______
______
Teacher’s Printed Name: ______
Teacher’s Signature: ______
Date
*Please retain a copy of this recommendation for your records.
TEACHER EVALUATION OF APPLICANT:
Name of Applicant: (please print)
______
LastFirstMiddle
INFORMATION RELEASE: Complete this section before giving recommendation to the teacher.
Under the terms of the Family Educational Rights and Privacy Act, ___ I waive ___ I do not waive any rights of access to this recommendation.
Applicant’s Signature: ______Date:______
Parent/Legal Guardian Signature: ______Date: ______
Dear Teacher,
Please give us with your professional judgment as to the applicant’s request to continue MIT-e.
Please complete and sign this form. Please return this recommendation to current MIT-e teacher.
*** Recommendation forms must be returned by March 3, 2014 ***
___ Highly Recommended to Continue MIT-e
___ Recommend to Continue MIT-e
___ Not Recommended to Continue MIT-e
Consistently / Often / Sometimes / NeverRate the student’s work and study habits:
Demonstrates ability to stay focused / 5 / 3 / 1 / 0
Completion of assignments on time / 5 / 3 / 1 / 0
Produces high quality of work / 5 / 3 / 1 / 0
Demonstrates ability to work alone / 5 / 3 / 1 / 0
Demonstrates ability to work in groups / 5 / 3 / 1 / 0
Utilizes all forms of communication effectively / 5 / 3 / 1 / 0
Exhibits life skills such as responsibility and accountability / 5 / 3 / 1 / 0
Rate the student’s conduct and behavior in class:
Interacts with adults respectfully / 5 / 3 / 1 / 0
Follows class/school rules and procedures / 5 / 3 / 1 / 0
Applies effective use of collaboration and cooperation skills / 5 / 3 / 1 / 0
Thinks critically, creatively, independently and originally / 5 / 3 / 1 / 0
COMMENTS: Please provide any other information that you think would be important for us to know about this student:
______
______
______
______
______
Teacher’s Printed Name: ______
Teacher’s Signature: ______
Date
*Please retain a copy of this recommendation for your records.