Grandview Middle School

RoboticsClub Application2016-17

The Robotics Club is being formed with a mini-grant from the Hickory Public Schools Education Foundation. This grant was used to purchase four Lego EV3 Mindstorms. Students selected for the Robotics Club will work in teams of 2 to design and build the Lego EV3s to complete projects and challenges.

The Grandview Middle School Robotics Club is open to 6th, 7th and 8th grade students, but space is limited to 8 students with 2 alternates. Mrs. Shuford will be the club sponsor. A selection committee will review the application forms and make selections based on the student/teacher responses.

The Robotics Club will meet on Thursday afternoons after school from 2:30 – 3:45 pm in Room 323. Students will need to make arrangements for transportation home and must be picked up by 3:50 pm.

If you are interested in applying for the 2016Grandview Middle School Robotics Club, download the application from

Applications are due no later than Wednesday,October 5 at 2:30 pm.

Please return the completed applicationto Mrs. Shuford in Room 323.

Students will be selected on:

  • Completeness of the application (questions answered thoroughly and returned).
  • Teacher recommendation.
  • Ability to work with a group of classmates on a project.
  • Enthusiasm, genuine interest and commitment to the Robotics Club.
  • Potential and ability to develop critical leadership skills. Respect for others.
  • Enthusiasm, cooperation, diligence, willingness to take chances.
  • Interest in science, mathematics, and technology.

Students will be notified by Friday, October 14, 2016. You will receive a letter and/or an e-mail.

GMS Robotics Club Application 2016-17

Please print neatly in blue or black ink.

Student Name (Full/Legal Name):______Grade: ______

Address: ______Zip:______

Home Telephone Number:______

Homeroom Teacher: ______Room #:______

Parent/Guardian Name:______

Parent/Guardian Email:______

Parent/Guardian Telephone (cell):______

List all of the extra-curricular activities that you are involved in and how often you participate in those activities (Family, school, community, religious activities, list the day of the week and time):

1.______

2.______

3.______

4.______

5.______

6.______

Please list any health or personal concerns that may affect your participation in the Robotics Club:

______

______

I understand that this program involves a huge commitment for students and parental support is essential to their success. My child has my consent to participate in the Grandview Middle School Robotics Club this school year. I will make sure that my child is picked up on time.

Parent Signature:______

Would you be willing to provide non-perishable snacks (fruit snacks, trail mix, cheese crackers, granola bars, etc.) for the club at least twice during the school year?

Please answer this self-evaluation. Please be honest in your response so that we may get to know you better.

Please give yourself a ranking of 1 to 5 with 1 being the lowest and 5 being the highest.

Skill / Ranking
Responsibility
Self-motivation
Respectfulness
Able to work independently and remain on task
Work well in a team and remain on task
Good computer skills
Good organizational skills
Good research skills
Good role model
Will take initiative
Helpful to other students
Can take constructive criticism
Math ability
School attendance

Have you ever participated in robotics? ______If so, list where and describe what you did.

Student Essay

Please write an essay (100 – 150 words) describing why you should be in the Grandview Middle School Robotics Club. Please include what special attributes and skills you have that would make you a valuable member of the club. Include large projects that you may have worked on and how well you work with a team.

Students may use the back of this form to write their essay or they may write/type their essay on another paper and attach it to this form.

I promise that if I am chosen for the 2016 Grandview Middle School Robotics Club, I will attend all meetings, work hard with my group, cooperate, be respectful with all participants and adults in the program, and be a worthy representative for the Robotics Club at all public events.

My signature pledges my commitment to these goals.

Student Signature______

Teacher Recommendation

To be completed by a teacher who has worked with the student.

Student Name:______Grade: ______

Please complete the following questions concerning this student’s application for the 2015Grandview Middle School Robotics Club. The goal of this program is to provide an opportunity for students to experience challenging hands-on science and engineering projects incorporating technology. Your input will helpdetermine the appropriateness of this student for theclub. If you have questions concerning this application, please contact Sherry Shuford.

  1. Describe your relationship with this student and how long you have known the student.

Please give a ranking of 1 to 5 with 1 being the lowest and 5 being the highest for the student in the following categories.

Skill / Ranking
Ability to work with peers on a group project
Hard work & persistence at working through a problem
Self-motivated and can take the initiative to do what needs to be done
Leadership ability and/or potential
Potential to benefit (personally or academically) from this program
Interest in math, science, and technology
Able to work independently and remain on task
Good organizational skills
Good role model
Helpful to other students
Can take constructive criticism
School attendance
  1. Other information you would like to share:
  1. My overall recommendation of this student for this program is (CHECK ONE)

______Do not recommend.

______Recommend with reservations. Please describe your concerns:

______Recommend as a good candidate for this program.

______Highly Recommend as an excellent candidate for this program.

TeacherSignature: ______

Please put your recommendation in Sherry Shuford’s mailbox by 2:30 pm on October 7th.