Martin W. Essex School for the Gifted Andtalented

Martin W. Essex School for the Gifted andTalented™

at Otterbein University

June 17-23, 2012

Application Materials

Application Due Date – February15, 2012

Martin W. Essex School for the Gifted and Talented™ at Otterbein University

GENERAL INFORMATION

1. The purpose of the Essex School is to provide enrichment experiences for rising twelfth grade students who are academically gifted and/or talented.

1. The School will operate June 17 – June 23, 2012 on the campus of Otterbein University. All meals will be provided in dining halls or will be catered by local restaurants.

1. Those selected will participate in a WEEK-LONG RESIDENTIAL summer enrichment experience that includes activities such as seminars, workshops and extended projects focusing on a variety of subjects, such as science, sustainability, the arts, and literature.

1. The School will explore academic and/or artistic pursuits at a level not always possible in the typical high school classroom. The topics addressed by the seminars and workshops will reflect the interests of the students, and will have an eye especially on salient contemporary issues.

1. Neither grades nor credits will be given; however, students will receive a certificate of participation at the conclusion of the School.

1. Students will have the chance to enroll in a one-credit hour course at Otterbein University during the autumn semester. In this course, students will deepen their engagement with the issues at the heart of a book that all students in the School will read and discuss—Rebecca Skloot’s The Immortal Life of Henrietta Lacks. All students will be sent a copy of this book after registering for the School.

1. The cost of the Essex program for 2012 will be $500. This cost can be assumed by family, district, and/or community of applicant. Financial assistance may be available for those who qualify. See application for more information.

1. Because time at the Essex School is limited, students will not be granted leaves of absence from the School; attendance at all of the School activities is mandatory.

1. All students must adhere to the rules and regulations as prescribed and communicated to them. Any violation of these rules may result in the student’s immediate dismissal from the School.

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All completed application packets should be forwarded to one of these Coordinators:

SUZANNE PALMER OR PATRICIA FARRENKOPF

K-12 GIFTED EDUCATION COORDINATOR K-12 GIFTED EDUCATION COORDINATOR

WESTERVILLE CITY SCHOOLS LICKING COUNTY EDUCATIONAL

936 EASTWIND DRIVE, STE 200 SERVICE CENTER

WESTERVILLE, OH 43081 675 PRICE ROAD

(614) 797-5887 NEWARK, OHIO 43055

(740)349-6083

*Applications will be read by an Advisory Committee made up of teachers.

Martin W. Essex School for the Gifted and Talented™ at Otterbein University

STUDENT INFORMATION FORM

Student Name:
Home Address:
Phone (include area code):
Email address:

Gender (check box): Female Male

Ethnic Background (check box):

Hispanics of any race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Two or more races

High School of Attendance:
School District:
Parent(s)/Guardian(s) Name(s):

Martin W. Essex School for the Gifted and Talented™ at Otterbein University

STUDENT ELIGIBILITY FORM

Instructions to Students

This form must be completed and signed by a gifted education coordinator, gifted education teacher, guidance counselor, principal, or psychologist. Submit the completed and signed form with your application.

Instructions to Educators:

To be eligible to participate in the Martin W. Essex School for the Gifted and Talented™ at Otterbein University, students must be identified as gifted in one or more areas.

Student’s Name: / Student’s Current Grade
School District / School Building / County
Area of Gifted Identification:
Superior Cognitive
Creative Thinking
Visual/Performing Arts / Specific Academic Ability
Mathematics
Science
Reading, writing, or a Combination
Social Studies
“I certify that the student named above meets the criteria for gifted identification.”
School Official’s Name (Print):

Limited financial assistance is available for those who qualify for the Free or Reduced Price School Meal Program. If applicant has given permission on the Student Information Form for release of this information by the school official, please read statement below:
“I certify the student named above does qualify for the Free or Reduced Price School Meals Program.”
This student qualifies for: Free Reduced Price
School Official’s Signature:______
School Official’s Telephone:______
School Official’s Position:

~Please include this form in student’s application packet~

Martin W. Essex School for the Gifted and Talented™ at Otterbein University

STUDENT ESSAY PROMPTS AND LETTERS OF RECOMMENDATION

Applicants to the Martin W. Essex School for the Gifted and Talented™ at Otterbein University are required

to write a short answer and extended response essay to be considered for admission to the School. Your essays should be word processed—i.e., typed, double-spaced, with standard margins. Please title your essays (titles do not count against your word limits) and type your full name in the top right corner of all pages. Submissions will be evaluated on originality, depth of introspection, and uniqueness of thought. The selection committee will strictly observe the word limitations. Please retain a copy of your compositions, as applications will not be returned to students.

Applicants are also required to submit two letters of recommendation with their applications. Letters of recommendation can be written by a teacher, school personnel (i.e. principal, guidance counselor, club advisor, etc.), or community member who can speak positively on behalf of the applicant.

Short Answer Prompt (Respond in 250 words or less):

Describe a social problem that you see becoming increasingly urgent in the future. What strategy or approach would you take in confronting—and perhaps alleviating or solving—this problem?

Extended Response Prompt (Respond in 500 words or less):

Provide a detailed example of a time in your life when you have had a positive impact on the life of an individual in the community or in a school.

Martin W. Essex School for the Gifted and Talented™ at Otterbein University

DISTRICT REPRESENTATIVE FORM

To be completed by the district representative in the student applicant’s school district:

Admission into the Martin W. Essex School for the Gifted and Talented™ at Otterbein University is competitive. The Essex School requires that any student applicant designate a representative to support the applicant’s application process, and—should the student be accepted—to assist with preparations for the Essex experience. A district representative (e.g., coordinator of gifted programs, teacher of gifted students, building principal, school counselor, etc.) must complete, sign, and return this form to the applicant for inclusion in his/her application packet.

I, the district representative supporting , agree to:

(student applicant)

1.Assist in the timely completion and collection of all forms comprising the application packet;

2.Serve as a contact person, both throughout the school year and during the summer weeks immediately preceding the program;

3.Receive copies of all information sent to the student from the Essex School, reinforcing pertinent deadlines;

4.Contact the student if he/she is selected as to ensure his/her presence at the School or to decline the invitation to participate in the event he/she cannot attend; and,

5.Ensure that the Essex School will be notified immediately should circumstance prevent the student from attending.

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District Representative Signature Date

District Representative Information:

Name

School District Name

School/Building Name

Office:

Street

City, State, Zip

Telephone

Summer, if applicable:

Street

City, State, Zip

Telephone

Email Address

~Please include this form in student’s application packet~

Martin W. Essex School for the Gifted andTalented™ at Otterbein University

PARENT/GUARDIAN PERMISSION FORM

To be completed by parent/guardian of student applicant:

I, the parent/guardian of , grant permission for him/her to apply to participate in the Martin W. Essex School for the Gifted and Talented™ at Otterbein University. If my son/daughter is accepted, I understand my obligation to notify the School’s coordinators immediately should he/she not be able to attend.

I acknowledge that the following conditions will apply:

1.The School will be held on the campus of Otterbein University in Westerville, OH.

2. All participants will abide by the rules and regulations set forth by the School; in particular, absence from

scheduled activities or departure from the campus at any time is prohibited, except in the case of an emergency.

3.Infraction of the rules and regulations set forth by the Essex School will be cause for immediate dismissal

from the Program.

I understand that this form must be completed, signed, and returned to the School coordinators as part of the student’s application packet; also, I recognize that submission of a fragmentary application packet will preclude a student from being considered for the Essex School. In signing below, I verify my understanding of the above-explained conditions.

Name of Parent/Guardian A:
(please print) / Date (xx/xx/xxxx):
Signature of Parent/Guardian A:
Name of Parent/Guardian B (OPTIONAL):
(please print) / Date (xx/xx/xxxx):
Signature of Parent/Guardian B:

Continued on page 2

Martin W. Essex School for the Gifted andTalented™ at Otterbein University

PARENT/GUARDIAN PERMISSION FORM

Attention Parents and Guardians:

Limited financial assistance is available to those who qualify for Free and Reduced Price School Meals. If your child qualifies for the Free and Reduced Price School Meal program at his/her school, he/she may receive a full or partial scholarship if selected as a 2012 Essex Scholar. This information will need to be verified by the school official. In order for the school official to verify qualification for Free and Reduced Price School Meals, your permission is required. Please read statement below and sign and date.

“My child qualifies for the Free or Reduced Price School Meal program at his/her school and I give my permission for the school official to verify the status of Free or Reduced Price School with the Martin W. Essex School for the Gifted and Talented at Otterbein University program coordinators. I understand this information will only be used for purposes related to financial assistance for the Martin W. Essex School for the Gifted and Talented at Otterbein University.

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Parent or Guardian SignatureDate