Math/Science Magnet Program at Morris Hills

COMMON APPLICATION PACKET

Deadline: January 7, 2011

Completion Instructions: The application below should be completed electronically. Use the “Tab” key to move forward between fields in the application or the “Shift” + “Tab” keys to move backward through the fields. Please complete all required information and then print the completed application. Once the application is completed, please obtain the required signatures and documents and return the entire packet to the address at the end of this packet. All applications must be return by January 7, 2011.

I am applying for: / IB / Math Science Magnet / Both

SECTION 1: Personal Information

Last Name / First Name / M.I.
Street Address / Apartment #
City/Town / State / Zip Code
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Home Phone / Cell Phone
Parent E-mail / Student E-mail
Ethnic Information (Optional): Ethnic information is required by the US Department of Health, Education and Welfare Office for Civil Rights. The Morris Hills Regional High School District does not discriminate in its admission policies and practices on the basis of race, color, national origin, sex, or disability. Morris Hills Values Diversity AA/EEO
Please check one: / Please check one:
Choose EthnicityAmerican IndianAsianBlack (non-Hispanic)CaucasianHispanicOther (please specify) / If other, please specify / Male Female

SECTION 2: Academic Background (To be signed by school counselor/administrator)

Below, please select your current middle school:

Choose Middle SchoolCopeland Middle SchoolMacKinnon Middle SchoolThomas Jefferson Middle SchoolValley View Middle SchoolOther (please specify) If other, please specify,

Which high school would you attend if you were not applying to the magnet program?

Choose High SchoolMorris Hills High SchoolMorris Knolls High SchoolOther (please specify) If other, please specify,

Are you currently enrolled in Algebra I? Yes No

Are you currently enrolled in: Spanish French Other No 2nd language

Is this program: Full Year Partial Year

Are you applying to any other specialized programs?

Yes No If yes, which program?

Does the applicant currently have or utilize:

an IEP? Yes No If yes, classification

504 Plan? Yes No

ESL course? Yes No

Has the applicant received Basic Skills services in the past two years?

Language Arts Yes No

Mathematics Yes No

Literacy Yes No

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Print Name of Administrator or Counselor / Phone Number
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Signature of Administrator or Counselor / Date

Parent/Guardian Release Statement

I have discussed this application with my child and hereby give permission for him/her to apply for admission to the International Baccalaureate (IB) Program at Morris Knolls or the Math and Science Magnet Program at Morris Hills High School.

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Student Signature / Date
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Parent/Guardian Signature / Date