EXCEL Summer Standards Camp
Student Application
Student Name: Mailing Address:
Phone Number: City:
Birth Date: Age: State: Zip:
Student State ID#: **Social Security:
Request for Confidential Information:
The Excel Summer program uses this information for reporting purposes only.
A) Sex: M F
B) Predominant Ethnicity: (Please select only one) __ Hispanic or Latino
__ Am. Indian or AK Native __ White
__ Asian __ Native Hawaiian or Pacific Islander
__ African American __ Other: ______
High School
Information: Name of School
Mailing address of school: address, city, state, zip
Telephone number of school: (area code and number)
If you have a High School counselor or a teacher that knows you and your academic skills please give us their name and telephone number or E-mail address:
I plan to graduate in (please circle one): 2011 2012 2013 2014
What are your current levels in:
______Math (District Graduation Level _____)
______Reading (District Graduation Level _____)
______Writing (District Graduation Level _____)
______Personal/Social (District Graduation Level _____)
Please list the sections of the High School Qualifying Exam that you have yet to pass:
_____ Reading _____ Writing _____ Math
Please include a copy of your Spring 2010 SBA and HSGQE results.
**Social Security number must be provided in order to receive college credits.
Parent or Legal Guardian Recommendation
This information gives us insight as to the applicant’s personality and potential. Please help us with the selection process by providing accurate and current information. The completed Parent/Guardian Recommendation form should be mailed with the students Excel Summer Standards Camp application packet.
Student Name: Parent Name:
Mailing Address: City:
State: Zip: Phone # or E-mail:
Why do you support this applicant’s participation in the Excel Summer Standards Camp program?
Participation in the program will require that applicant to live away from his/her home for four weeks. Do you have any reservations concerning the applicant’s ability to handle the extended absence from home?
What extra-curricular activities has this student participated in?
What events in this student’s life may influence his/her potential for success in school?
Briefly comment on this student’s strengths and weaknesses.
Does your son or daughter have any major medical issues we should be aware of?
I have read, understand and discussed the information in this application with my son/daughter. I support and agree to his/her participation in all activities, both academic and recreational, if my child is selected to participate.
Parent Signature: Date:
EXCEL Summer Standards Camp Student Application
EXCEL Summer Standards Camp
Student Application
TEACHER RECOMMENDATION FORM
Student Name: District/Site:
Recommending Teacher: Date:
Please score the student in each of the four areas of personal /social using the following rubric. The student’s success will ultimately be determined by their Personal Social skills.
1=Emerging / 2=Developing / 3=Proficient / 4=AdvancedCommunication/ Life Skills
/Actions express a limited understanding of manners, respect for others, need for communication and group-living skills. /
Prompting is necessary for appropriate manners in some situations, completion of chores, and eye contact. /
Exhibits appropriate manners; Respects others; Completes chores; Maintains eye contact; Demonstrates proper introductions /
Exhibits excellent manners and respect in all situations; Looks for opportunities to interact with others and models for peers.
Problem-Solving/ Decision-Making /
Displays limited problem solving and decision-making. /
Demonstrates difficulty with focus; Begins to understand processes for problem solving and decision making /
Works with others using decision making and problem solving skills. /
Encourages others to participate; Exhibits leadership skills and is admired by peers for it.
Teamwork
/
Exhibits difficulty in working as a part of a team. /
Needs encouragement to participate in the group, participates in limited ways /
Participates in team activities and works well within a group. /
Encourages others to participate and helps peers develop their skills
Goal-Setting
/
Demonstrates limited understanding for timeliness and the goal setting process; Expresses difficulty in assessing own strengths/weaknesses. /
Prompting is necessary for being on time; Assistance is needed to complete tasks; Preparation and follow through are inconsistent; Begins to assess strengths/ weaknesses /
Practices good attendance and being on time; Makes and revises goals in order to accomplish tasks; Recognizes own strengths and weaknesses /
Exhibits self-direction and initiative in setting goals; Works toward self-improvement and is willing to try new experiences
Comments on Communication / Life Skills
Comments on Problem Solving / Decision Making
Comments on Teamwork
Comments on Goal - Setting
Other General Comments / Skills I would like to see this student return with
If the above student is not proficient in the four subject areas of P/S/H do you feel that if taken out of their current environment they may show growth in these areas?
Teacher Signature: Date:
EXCEL Summer Standards Camp Student Application