/ Los Angeles Unified School District
Gifted/Talented Programs

ATTACHMENT A

2017–2018

School for Advanced Studies (SAS) Student Permit Application

Application period is from March 1 through March 30, 2017.

For students who reside within LAUSD boundaries and are applying to an SAS site outside their residential area.

Transportation is not provided. This application cannot be used for affiliated charter schools with the SAS designation.

The entrance level to SAS sites is from grades K–12. Processing is dependent upon accurate and complete information.

Please PRINT in INK and fill out completely. Completed application must be submitted to the SAS school of choice.

A

SAS School of Choice (SAS site to which student is applying)

A

Student Last Name First Name Initial

A

Current School of Attendance

A

Parent/Guardian Last Name First Name Initial

A

Home Address Apt. /Unit No.

A

City/State ZIP Code

- / -

Area Code (Home number Cell number) Area Code (Work or Emergency Phone)

Student Information: (School staff must sign and confirm student’s eligibility by completing pages 2–3.)

Birth date / / / Student Ethnicity (Check one)
1. American Indian/Alaskan Native 4. Latino
2. Asian 5. White
3. African American or Black 6. Pacific Islander
Student’s Grade Next School Year
Parent please complete top portion, sign the application and submit it to the school of attendance for verification.

______E-mail

Signature of Parent/Guardian (Signature acknowledges awareness that the SAS program does not Date

provide transportation services.)

______

Signature of Administrator (or designee) of Current School of Attendance Date

(Signature acknowledges that the applicant meets eligibility criteria and that the sending school must complete

the MiSiS Transfer process for accepted/confirmed students; sending school must keep supporting evidence on

file at school site for five (5) years; subject to audits.)

______

Signature of Administrator (or designee) of SAS School of Choice Date

(Signature acknowledges receipt of application.)

FOR OFFICE USE ONLY (Receiving School/SAS School of Choice)

APPLICATION APPROVED APPLICATION DENIED LOTTERY-LIST NUMBER

BY: POSITION:

STAPLE AND DUPLICATE APPLICATION (BACK-TO-BACK) BEFORE DISTRIBUTING

ATTACHMENT A

APPLICATION PROCESS: The application must be completed and signed by the parent/guardian and the principal/ designee of the school of attendance, and submitted to the SAS school(s) of choice. For the appropriate educational placement of very young children (K–1), it is recommended that a brief interview and review of work samples be included to complete a student profile. The teacher or administrator familiar with student’s eligibility must also sign the application. See below.

CRITERIA: TO BE COMPLETED BY SCHOOL ADMINISTRATOR/DESIGNEE

SAS sites are open to applicants currently in grades Pre-K–11 who reside within the LAUSD boundaries AND who demonstrate superior academic achievement/potential. The student’s current school of attendance must verify that the applicant meets ONE of the following criteria items:

1. Student is identified as gifted/talented in LAUSD in the Intellectual High Achievement Creative Ability Leadership Ability or Specific Academic in English Math Science Social Science

2. Student scored in the “Standards Exceeded” range on the 2016 SBAC assessment in both ELA and Math. Yes No OR has TOTAL national scores of 85% or above on a District-approved standardized achievement test in required areas (most recent year only). Indicate percentile in:

a.  OLSAT-8 (spring 2016): APR total OR

APR Verbal and APR Non-Verbal OR

b.  Name of District-approved standardized achievement test:

Total Reading or ELA: and Total Math: OR

Reading Composite: and Math Composite: OR

Verbal Reasoning: and Quantitative Reasoning:

3. School staff must check “Yes” for all four skills for the students to qualify with this criterion.

a. Student demonstrates the ability to meet ALL FOUR of the critical-thinking and problem-solving skills in primary language:

Yes No Explain meanings or relationships among facts, information or concepts that demonstrate depth and complexity.

Examples:

·  Analyzes similarities and differences in events, people and things.

·  Displays high level observation skills that frequently detect fallacies and inconsistencies.

·  Grasps new concepts easily; moves rapidly from familiar (concrete) to unfamiliar (abstract).

·  Sees hidden meanings or cause-and-effect relationships that are not obvious.

·  Analyzes and evaluates respective solutions from multiple points of view.

Yes No Formulate new ideas or solutions and elaborate on the information.

Examples:

·  Plans unique projects by integrating learning from different areas.

·  Produces detailed steps of a solution and sound reasons for them.

·  Invents solutions to established problems; creates problems for which there are no apparent solutions.

·  Approaches tasks in different, unusual, and original ways.

Yes No Use alternative methods in approaching new or unfamiliar mathematical problems.

Examples:

·  Locates, selects, and uses relevant information and material.

·  Gives examples of possible outcomes; makes "educated guesses."

·  Thinks of and asks provocative questions which involve logical thinking processes.

·  Changes word problems into mathematical terms or formulas.

·  Uses standard math processes and proficiencies such as problem-solving, abstract reasoning, constructing viable arguments, etc.

· 

ATTACHMENT A

Yes No Use extensive vocabulary easily and accurately to express creative ideas.

Examples:

·  Demonstrates a vivid imagination in a variety of products.

·  Shows unusual ability to express self, feelings, concepts, etc.

·  Plans and selects alternative means to demonstrate creative ideas.

·  Demonstrates fluent, concise, and creative self-expression.

·  Uses a large vocabulary in home language.

·  Shows ability to “code switch” and uses language appropriate to specific disciplines, situations, and audiences.

b.  Applicants verified through the four critical-thinking and problem-solving skills must also demonstrate the ability or strong potential to work two years above grade level in academic subjects. Please list most recent grades below, if applicable:

SUBJECT / GRADE
Language Arts: Reading/English
Language Arts: Writing (elementary only)
Mathematics

c.  For students verified with the critical thinking and problem solving skills criterion only, a portfolio should be created to support verification or non-verification of the potential ability to meet ALL FOUR critical-thinking and problem-solving skills in student’s primary language AND ability or strong potential to work at least two grade levels above. The student portfolio should be kept on file at the sending school for five (5) years (do not submit with application unless requested for K–1 applicants). Examples of documentation/supporting evidence that may be included in the student portfolio are as follows:

·  Writing sample(s) that showcase extensive vocabulary

·  Drawings/multi-media files

·  Annotations of class activities and discussions/journals/logs

·  Examples of assignments and projects that demonstrate depth and complexity

·  Examples of new or creative thinking

·  Examples of students using alternative methods in approaching new or unfamiliar mathematical problems (i.e.: constructed response)

·  Letter of recommendation from person of choice (recommended current teacher)

·  Formative and summative assessment examples (e.g. reading inventories showing above grade level abilities)

·  Cumulative project examples

VERIFICATION (Only a teacher or administrator can verify a student’s achievement.)

Print Name of Staff

Verifying Data: Title:

Signature:______Date:

School: Phone: ( )

School Address (if private or charter):

City/State: ZIP Code:

MEM-5974.4

Division of Instruction Page 1 of 3 January 31, 2017