Pike Agriscience and TechnicalCareerAcademy
Application 2012
**Offered to students in PikeCounty, TroyCity, and surrounding school systems.
Student Profile Sheet
First NameMiddle NameLast Name
Address
CityStateZip Code
Social Security #Current Grade
Parent/Guardian Name Relationship to Applicant
Home Phone #Cell Phone #
Applicant’s Date of BirthSchool Currently Attending
Required Information/Documents
- Student Profile
- Agreement of Understanding
- Three recommendation forms (see attached)
- One page essay that explains why the applicant would like to be accepted in to the Academy and name any special skills and/or interest that would help them succeed in the Academy.
- Students coming from private school, home schooling or out of district schools must provide the following: a copy of the birth certificate, an updated immunization form, and a sealed official academic transcript and test scores.
Agreement of Understanding
By signing below, I acknowledge my understanding of the following conditions for this application:
- The deadline to submit the application is April 16, 2012.
- Failure to complete ALL requested information will cause this application to be rejected.
- Additional admission may be necessary and these must be completed and submitted as part of the application process, when requested.
- The basis for acceptance in the Academy is academics, attendance, conduct, effort, and a strong interest in agriculture.
- I understand this is only an application to be considered for admission and not a guarantee.
- Acceptance is provisional based an an overall GPA of a 2.5.
- I understand that membership in the FFA and 4H is a requirement to be in the Academy.
- I understand that I will have to have an SAE (Supervised Agriculture Experience Project) that includes animal raising, plant growing, on farm job, etc. just to name a few of the projects offered.
- I understand that I will have to perform 60 hrs of community service during the 2 years I am a member of the Academy.
- I understand that Chemistry and Agriscience are pre-requisites classes for the Ag Academy.
I hereby give permission for my child to be screened and interviewed for admission to the Academy. If accepted, he/she will be enrolled as a full-time Academy student. My child must demonstrate acceptable performance (as determined by school-site policy) in order to remain in the Academy.
______
Parent or Legal Guardian SignatureDate
Academy Recommendation
Student Name______
Teacher__Counselor__Principal__
Name______
Please use the following rating scale:
Frequently 3 Sometimes 2Seldom 1 Unable to observe O
__ Demonstrates initiative in exploring ideas
__ Is enthusiastic about projects
__ Takes leadership roles
__ Is attentive
__ Produces a variety of ideas and responses
__ Follows through on assigned tasks
__ Accepts constructive criticism
__ Follows direction
__ Works independently
__ Works well in groups
__ Is able to transfer knowledge
__ Is self-motivated
__ Works academically at or above grade level
__ Total
Additional comments:
Check one of the following:
I recommend _____I do not recommend ____ this student for admission to the Academy.
______
SignatureDate
Academy Recommendation
Student Name______
Teacher__Counselor__Principal__
Name______
Please use the following rating scale:
Frequently 3 Sometimes 2Seldom 1 Unable to observe O
__ Demonstrates initiative in exploring ideas
__ Is enthusiastic about projects
__ Takes leadership roles
__ Is attentive
__ Produces a variety of ideas and responses
__ Follows through on assigned tasks
__ Accepts constructive criticism
__ Follows direction
__ Works independently
__ Works well in groups
__ Is able to transfer knowledge
__ Is self-motivated
__ Works academically at or above grade level
__ Total
Additional comments:
Check one of the following:
I recommend _____I do not recommend ____ this student for admission to the Academy.
______
SignatureDate
Academy Recommendation
Student Name______
Teacher__Counselor__Principal__
Name______
Please use the following rating scale:
Frequently 3 Sometimes 2Seldom 1 Unable to observe O
__ Demonstrates initiative in exploring ideas
__ Is enthusiastic about projects
__ Takes leadership roles
__ Is attentive
__ Produces a variety of ideas and responses
__ Follows through on assigned tasks
__ Accepts constructive criticism
__ Follows direction
__ Works independently
__ Works well in groups
__ Is able to transfer knowledge
__ Is self-motivated
__ Works academically at or above grade level
__ Total
Additional comments:
Check one of the following:
I recommend _____I do not recommend ____ this student for admission to the Academy.
______
SignatureDate