Pender Early College High School

PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOL

A Pitt County Schools – Pitt Community College Partnership

1959 Warren Drive

Winterville, NC 28590

252-493-7821

APPLICATION FOR ADMISSION

Demographic Data: (This information will be used for State/Local Reports)

Student Name: ______

LastFirstMiddle

Current School: ______

Sex: __ Male __ Female- Birthdate ____/_____/_____ State of Birthplace: ______

Month Day Year

Mailing Address: ______City: ______Zip______

Home Address: ______City: ______Zip______

Student Email Address: ______

Home Telephone Number: ______Student Cell Phone Number: ______

Ethnicity/Race:

______American Indian______Alaskan Native ______Asian/Pacific Islander ______Black

______Hispanic ______White ______Multi-Racial ______Other

Parent/Guardian Information:

Mother’s Name: ______Father’s Name: ______

Guardian (if applicable): ______Relationship to Student: ______

Mailing Address (if different from student): ______

Parent(s) Work Number: ______Parent(s) Cell Phone Number: ______

Place of Employment: (M) ______(F) ______

Parent(s) Email Address: ______

Parent(s)Highest Educational Level Attained (Place an “M” for Mother/”F” for Father) even if the parent(s) are not in the home:

_____Did not graduate high school ____High school graduate____ Some college/Certificate

_____Completed Associate Degree ____Completed Bachelor’s Degree

_____Completed Master’s Degree _____Completed Doctoral Degree

Applications must be fully completed in order to be reviewed.

Application deadline is February 26, 2016 and should be submitted to your counselor.

Date application submitted to your school counselor______

PittCOUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOL Admission Essay

The Pitt County Schools Early College High School is a rigorous program designed to provide students with an opportunity to earn a High School Diploma and an Associate degree at no cost to the student. It requires a strong work ethic and a commitment to success. In 500 words or less, in your own handwriting, explain what you think it will take for you to successfully meet the challenges in completing this program. Provide examples of your work ethic from past experiences in school.

______

Student Statement

Sign below if you agree to the following:

I understand that my commitment to Pitt County Schools Early College High School is for at least one full academic year.
I expect to complete a two-year degree program while at Pitt County Schools Early College High School.
I am able to complete the Future Ready Core Course of Study.
I will maintain high academic and behavior standards.
I understand that there are no athletic or ROTC programs and limited clubs at Pitt County Schools Early College High School.
I understand that Pitt County Schools Early College High School will operate on the Pitt Community College school calendar, NOT the calendar of Pitt County Schools.

I have read these statements and I agree to abide by them as well as the rules and policies of Pitt County Schools Early College High School

Student Signature: ______Date: ______

Parent/Guardian Statement

(To be completed by parent/guardian)

Students succeed best when the school, the parent/guardian, and the student work together. Please sign below if you agree to the following expectations as parent/guardian:

I understand that my child’s commitment to Pitt County Schools Early College High School is for at least one full academic year.
I agree to make every effort to ensure my child is in school every day.
I agree to attend and support school functions.
I understand that my child must be able to complete the Future Ready Core Course of Study.
I will encourage and expect high academic and behavior standards from my child.
I understand that there are no athletic or ROTC programs and limited student clubs.
I understand that Pitt County Schools Early College High Schoolwill operate on the Pitt Community College calendar, not the Pitt County Schools calendar.
I agree to encourage my child to abide by the rules and policies of Pitt County Schools Early College High School

Name of Parent/Guardian and Signature: Date: ____________

By my signature below, I agree to the following:

I give permission for the Child Nutrition Director in the school district to confirm the student is currently eligible for free or reduced price meals at school, or for the principal or guidance counselor to certify that the student is eligible for Need Based assistance.

Signature of Parent or Guardian: ______Date: ______

TO BE COMPLETED BY SCHOOL COUNSELOR OR PRINCIPAL DESIGNEE ONLY

Both the student and parent sections should be completed BEFORE the counselor or principal designee completes this section.

Applications must be fully completed in order to be reviewed.

Student Name: ______PowerSchool Number ______

Person completing form: ______Title: ______

Please complete the following information about the applicant.

Please check one:

Exceptional Children: ______Yes ______No

If yes, please state area(s) of exceptionality ______

If this student is EC, what course of study is he/she pursuing? Please check one:

______Future-Ready Core ______Future-Ready Occupational

504 Plan: Yes______No______Accommodations: ______

Is this student AIG? _____ Yes ______No

Does this student receive ESL Services? ______Yes ______No
Discipline: Number of Incidents: 7th Grade______8th Grade______

Please explain any extenuating circumstances______

______

How many absences did this student have in 7th grade?______Currently in 8th Grade______Please explain any extenuating circumstances______

______

Testing Information: Please attach score reports or complete the section below.

7th Grade EOG Scores: Math Percentile ______Level ______

Reading Percentile ______Level ______

______

The Pitt County Schools Early College school counselor will follow up with you in June to obtain 8th grade EOG scores (if unavailable at time of application).

I verify that the information listed is true and accurate to the best of my ability.

Signature: ______Date: ______

PittCounty Schools Early College High School Teacher or Counselor Recommendation

(Confidential Information-Please return to student in sealed envelope)

Student Name: ______PowerSchool Number ______

Current School: ______Grade Level: ______

Recommendation completed by: (Please print) ______

The above student is applying for admission to PittCounty Schools Early College High School, which is located on the main campus of Pitt Community College. This recommendation is for the 2016-2017 school year. Students enrolled in this program simultaneously complete their high school education and an Associate Degree or a two-year degree program. Your responses will be valuable in helping the Review Committee to identify which students will benefit and succeed in this program. Without this recommendation form, a student’s application is incomplete and will not be reviewed for admission. If you have any questions please contact Principal Wynn Whittington at or Counselor-Ms. Bernetta Bradley at Pitt County Schools Early College High School.

Please check any characteristics that apply to this student:

___ bright/intelligent ____ shows leadership capabilities

___ demonstrates artistic abilities ____ seeks academic challenges

___ participates in class discussion ____ eager to join the adult world

___ desires more freedom or independence ____ shows little/no interest in learning

___ demonstrates consistent academic effort ____ consistent discipline problems

___ performs to potential ____ needs help with career goals

___ needs personal attention and encouragement ____ capable of performing at higher level

___ follows through on homework assignments retained in grades______

___ disassociates from middle school activities

___ experiences struggles common to today’s teens (divorce, loneliness, peer pressure, etc.)