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

  1. Student Profile
  2. Agreement of Understanding
  3. Three recommendation forms (see attached)
  4. 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.
  5. 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