PALs 1 Application

For the 2013-2014 school year

(Class of 2014 or 2015 may apply)

Applicant Name: ______Class of: 2014 2015

Cell phone #:______Email (mandatory): ______

Languages other than English: ______

Important Info:

Applications due: Tuesday, April 2nd to classroom F153 by 3:45pm

Interviews: April 8th - 16th (during 1st period & lunches)

Announce New PALs: Friday, April 26th

*There is a $50 membership fee for each PAL that can be paid in full at the beginning of the year or $25 each semester. The membership fee will pay for the PALs polo shirt, PALs t-shirt and various activities throughout the year.

*Completely fill out the following packet. Incomplete packets will not be considered.

*Two teacher recommendation forms are required. These are confidential and should NOT be returned to the applicant. They are to be placed in Jennifer Clements’ mailbox by the teacher only. These are located at the back of the packet. Tear them out and give them to your teachers.

Please fill out your current schedule entirely, including room numbers:

A Day B Day

Lunch: ______Lunch: ______

Class / Teacher / Room # / Class / Teacher / Room #
1st / 1st
2nd / 5th
3rd / 6th
4th / 7th
8th / 8th
  1. What is a PAL? What do you expect to gain from being a PAL?

______

______

______

  1. How important do you think service hours are? What service hours have you

participated in? ______

______

______

  1. What activities are you involved in at school? Outside of school? Work?

______

  1. Write 3 words that you feel best describe your personality:

______

  1. What is a mentor? Why is mentoring important?

______

  1. Which of the following would you be willing to do?

(Check all that apply to you) Would you:

____ Give up your lunch period occasionally to work with a student.

____ Be available before/after school for a meeting.

____ Be willing to attend a summer training session.

____ Be willing to contact students on the phone.

____ Be able to attend weekend activities.

  1. List and explain your major strengths and weaknesses.

______

______

  1. Why do you consider yourself a leader?

______

______

  1. How do you gain a person’s trust?

______

10. Describe your attendance and tardy record.

______

11. Have you ever participated in PALS before?

8th grade PAL? Yes No School: ______Sponsor: ______

9th grade PAL? Yes No School: ______Sponsor: ______

12. What kind of personal behavior choices do you think are important for a peer leader to make?

______

13. What makes you different from your peers? How do you stand out?

______

______

______

14. What else would you like for us to know about you? What else do we need to know about you? Describe any personal hardships that you are willing to share.

______

______

______

______

16. In which computer programs are you proficient? ______

  1. Do you have your own transportation? ______
  1. Have you ever had a physical or verbal confrontation with a teacher, peer, or

staff member? If so, explain in detail. ______

______

______

  1. Have you ever received a referral? If so, explain. ______

______

  1. Do you have a Facebook page? ______Twitter Account? ______Instagram Account? _____

If so, do your parents view your pages? Yes No

May your potential PALs sponsor view your pages? Yes No

PAL Contract

PALs is a TEA approved course, local credit, which focuses on mentoring at risk students at the elementary, middle, and freshman center levels, as well as the Dillard Center. PALs also oversee the welcome of new students to AHS. Community service hours each nine weeks are also required

(15 hours- PALs 1 & 20 hours – PALs 2).

PALs agree to:

-Be tobacco, alcohol, and drug free.-Attend all classes regularly and punctually.

-Maintain passing grades in all classes.-Be honest and maintain integrity.

-Attend to PALee(s) during assigned time.-Be respectful to all teachers and peers.

-Keep and promote a positive attitude.-Represent the PAL Program with dignity & pride.

-Be a positive role model.-Follow rules in the Student Code of Conduct.

-Complete PALee reports each nine weeks.-Complete service hours needed.

I have read and understand all PAL requirements listed above. Failure to disclose any needed information to my potential PAL sponsor may result in non-admittance to the program.

Applicant Name: ______Signature: ______Date: ______

Applicant Name: ______

PALs 1 – Peer Assistance and Leadership

CONFIDENTIAL Teacher Recommendation

To maintain confidentiality, do NOT give this form back to the student.

Please return this form by Tuesday, April 2nd to Jennifer Clements’ mailbox.

This student is applying to be a PAL peer helper. These peer helpers will undergo extensive training courses before they begin working with other students at the high school and feeder schools. Remember, the students in this course do not necessarily have to be academically strong. They must exhibit qualities of empathy and caring.

Name of Recommending Teacher______

Date Received ______

Rate this student from one to five in the following categories.

(One being the lowest and five the highest)

Trust level with others _____

Leadership_____

Cooperation _____

Emotional Maturity _____

Listening _____

Dependability _____

Self Discipline _____

Self Confidence _____

Ability to work w/ minimum supervision _____

Overall Recommendation

(Please check one)

Strongly Recommend_____

Recommend_____

Recommend with reservation_____

Do not recommend_____

Optional – on the back of this sheet, please write a short paragraph about this student including personal characteristics and potential.

Applicant Name: ______

PALs 1 – Peer Assistance and Leadership

CONFIDENTIAL Teacher Recommendation

To maintain confidentiality, do NOT give this form back to the student.

Please return this form by Tuesday, April 2nd to Jennifer Clements’ mailbox.

This student is applying to be a PAL peer helper. These peer helpers will undergo extensive training courses before they begin working with other students at the high school and feeder schools. Remember, the students in this course do not necessarily have to be academically strong. They must exhibit qualities of empathy and caring.

Name of Recommending Teacher______

Date Received ______

Rate this student from one to five in the following categories.

(One being the lowest and five the highest)

Trust level with others _____

Leadership_____

Cooperation _____

Emotional Maturity _____

Listening _____

Dependability _____

Self Discipline _____

Self Confidence _____

Ability to work w/ minimum supervision _____

Overall Recommendation

(Please check one)

Strongly Recommend_____

Recommend_____

Recommend with reservation_____

Do not recommend_____

Optional – on the back of this sheet, please write a short paragraph about this student including personal characteristics and potential.