STMC Student Application Forms (8/22/2013)

STMC Student Application Forms (8/22/2013)

STEMM Technical Middle College

FALL2013ADMISSIONPOLICY & APPLICATION FORMS

Closed
Admission / HCCsetsdeadlinesforapplications andadmission priorto thebeginningof each
newacademicyear.Although there is open admission during 2013-2014, priority will be given to applications that have been signed by high school principals by September 6, 2013. Please note that for the 2014-2015 school year and subsequent school years, deadlines will be earlier in the calendar year. New application deadlines will be announced during or before December 2013.
Fall2013
Admission
Timelines / September 6,2013,5:00p.m. –Deadline for PRIORITY consideration
oApplicationsreviewedin orderof receipt
oApplications signed by principals after September 6 may be considered throughout the school year for admission during Fall 2013 or in January 2014.
Selectionfor
Enrollment / The total enrollment of STMC will be limited by Hagerstown Community College. Enrollmentselectionpriorities are as follows:
1. At least 50% of all STMC students must be first-generation (parents do not have college degrees).
2. Students in 9th grade currently residing in Washington County.
3. Students in 11th grade who have completed high school credits as shown in this package and currently residing in Washington County.
4. All students in 11th or 12th grade must be college-ready as determined by Accuplacer assessments or standardized test (ACT or SAT) scores.
5. Students approved to participate in the STMC must maintain a 3.75 high school GPA during Grades 9 and 10 (or have maintained such a GPA) or be approved by Washington County Public Schools (WCPS) based on placement test scores.
6. All students starting STMC in 11th or 12th grade must have achieved a passing score on all High School Assessments or state-mandated tests and must have fulfilled their Student Service Learning Requirement.
Lottery
(if necessary) / Ifthenumberof students who submitcompleteenrollmentpacketstoHCCwhose enrollment packets meet all established criteria bythedeadline of5:00p.m.on August 14islargerthanthenumberofavailableslots for the2013fallsemestercohort,alottery maybe held.
ThelotterywillbeconductedbyaHCCadministrator.Thelotterywilldetermine whoisadmittedforthe2013fallsemestercohortandwho will beplacedona2013 fallsemestercohort waitlist.Thewait listwillremain ineffectuntil the2013fall semesterbegins.
Lottery
Selection / Studentswhosenames are drawnin thelottery,afterallavailableslotshave been filled,will be placedon a waitlist.Ifapreviouslyacceptedstudentdecidesnot to attendHCCbeforethefirstdayof fall classes,thenextstudenton thewaitlist willbeofferedthatslot.
Lotteryand
Familieswith Multiple Enrollees / Familiesthathavemorethanonestudenthopingtoenroll inHCChavethe
option of placingthestudentsinto thelotteryasindividuals or asafamily.Ifyou choosetoenteryour studentsintothe lotteryasindividuals, each willbetreatedas anindividualenrollee.Ifyouchoosetoenterasafamily, allsiblingsin thefamily will be eligiblefor enrollmentif thefamily isselected.Ifyouchoosetoenteryour studentsintothelotteryasa family, indicatethisby checkingthelotterypreference box onthe StudentInformationForm.

o

STEMM Technical Middle College

EEO/TitleIX/ Section 504 Statement

STEMM Technical Middle Collegedoesnot discriminateonthe basis of race,gender, color, religion,national origin, age,disability, height, weight, marital status, or veteranstatus inprovisionofits educational programsandservices with the requirements of TitleIXofthe EducationalAmendments of 1972, Public Act 453, Section504of theRehabilitationActof 1973, TitleVIIof theCivilRights Act of 1964as amended, Public Act 220, and theAmericans with Disabilities Actof 1990.

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC Student Application Forms (8/22/2013)

ADMISSIONREQUIREMENTS

FALL2013SEMESTER

Studentseligibletoenrollin the Fall2013SemesteratHCCmustmeetthefollowingcriteria:

AllEligibleStudents

•Youmustbea9th, 10th, 11th, or 12th grade studentduringthe2013-2014school year.

•If you are entering 11thor 12thgrade, priority will be given to students who have completed high school credits as shown below. It is assumed that 11th graders coming to the STMC have completed 14 of 24 required high school credits.

•Youmustbe17yearsof age or youngeronSeptember1,2013.

•YoumustbearesidentoftheStateof Maryland.

EarnedHighSchoolCredits
•Youmusthaveearnedhighschoolcredit,asdescribedbelow,atthetimeofenrollment.
10thGradeApplicants / 11thGrade Applicants
oEnglish –1credit
oMath- 1credit
oScience- 1credit
oSocial Studies–1credit
oForeign Language-1credit
oTech Ed-1credit (may also be taken in 10th grade)
oElective-1credit / oEnglish –2credits
oMath–2credits
oScience–2credits
oSocial Studies–2 credits
oForeign Language–2 credits
oFine Arts-1credit (may also be taken in 9th grade)
oElectives–3credits

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC Student Application Forms (8/22/2013)

DONOTTURN IN THEPACKET UNTIL THISCHECKLISTISCOMPLETE APPLICATION CHECKLIST

Student InformationformCopyof Current Visa(ifnot American citizen) Affirmationof Citizenship Form Copyofbirth certificate

Student ResidencyQuestionnaireProofof required immunizations

DTaP(Diphtheria,Tetanus,Pertussis)

AffirmationofPriorDisciplineRecordform- 3 doses

TD/Td(Tetanusbooster)

Statement ofEligibilityforSupport Services- 1 doseinthelast5 years

Current IEPT/MET/Section 504Plan reportsOPV(Polio)

included, ifnecessary- 3 doses

MMR(Measles,Mumps, Rubella)

SignedHomeLanguageSurvey- 2 doses

HepB(HepatitisB)

TruthandAccuracyform-3 doses

Varicella(ChickenPox)

HCCAccuplacertest results

MathMeningococcal(meningitis)

Reading

WritingEnrollment Essay-seeDirectionsfortopicofessay

1 - 2 pages,12 point font,1" page margins

Student-Parent-School-HCC Contract

Credits- 9th grade

English

Officialhighschooltranscript ANDScience

SocialStudies

Copyof most recent gradecard Elective

Other(not required)

Other(not required)

Proofof Residency(choose2 fromthelist below)

Driver'sLicenseCredits- 10th grade

Voter's RegistrationEnglish

LeaseAgreement Math- Geometry/Algebra II/Trig/PreCalc

MortgageBill(within last 90days) Social Studies

Taxbill(within last 6months) Science

Utility Bill(within last 90days) Elective

Elective Elective

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC Student Application Forms (8/22/2013)

HCCACCUPLACERASSESSMENTFORM

STMC MATHPLACEMENTFORM

Take this completedformto theTesting Centerlocatedin Room322ofthe Learning Resource Center buildingon thecampusofHCC.This formisonlyvalidfor admissiontestingto STMC and replaces the usual HCC student ID number required for testing. Please bring a photo ID with you at the time of testing. Testing is done on a walk-in basis.

Student’sName: (pleaseprint):

Student’sSocialSecurityNumber:

NormalscheduledhoursfortheTestingCenter:

Days / Hours
Mondays –Thursday / 8:00AM–10:00PM
Friday / 8:00AM–5:00PM
Saturday / 9:00 AM – 3 PM

Ifyouhaveanyquestions, youcan contacttheTesting Centerat240-500-2398.The Center’s currenthoursandlocationcanbefoundatthisURL:

BesuretorequestacopyofyourAccuplacerscoreswhenthetestiscompleted.Acopyofthe

Accuplacerscoresheetisto beturnedinwiththecompletedapplication.

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

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STMC Student Application Forms (8/22/2013)

WHAT ISSTEMM TECHNICAL MIDDLE COLLEGE?

Mission / STEMM Technical Middle College(STMC)isa partnership between Hagerstown Community College and local secondary schools.With sustainedsupport andguidance,studentsengagein rigorousacademics andlifemanagementskills toearnahigh schooldiplomaand at least 30 college credits. Many students will earn college certificates or degrees.
AMiddleCollege
Experience / STMCstudentsjointlyenroll atHagerstownCommunityCollege(HCC) and as high school students,andarerequiredto meetallpre-requisites, requirementsand conditionsofHCCstudents.
Successful
STMCStudents / STMC students take responsibility for their own effort, decisions,
education and behavior. There are no bells, hall monitors or daily announcements to keep them on track. The STMC Counselor/Coordinator works with students and serves as coordinating teacher. Students must monitor their own progress and advocate for themselves in a complex environment.
Successful
STMCParents / Parentsencourage theirstudenttotake responsibilityfor theirown efforts,decisions,education, andbehavior.Studentsmustlearn to advocatefor themselveswhendealingwithboth STMCandHCCpersonnel.
TheSTMC
Program / STMCisaskill basededucationalprogram.WhilemeetingtheUniversity of Maryland completerrequirements,STMCstudentsacquireand demonstratehard (academic)and soft(lifemanagement)skills.Priorto transitioninginto thecollegeportionof theprogram,STMCstudents must
•demonstrate readiness for college-level academic workAND
•demonstratecollege-readysoftskillsin allclasses.
Inaddition to completingcoreacademicrequirementsstudents complete a technicalcertificateorassociatedegreefrom Hagerstown Community College.Basedon theirEducationalDevelopmentPlan(EDP),STMCstudentschoose a program at HCC and concurrently meet University of Maryland Completer/high school graduation requirements, high school testing requirements, and service learning requirements.
Coordinator/
Counselor / The STMC Coordinator/Counselor meets frequently with students; these meetings are a requirement for participation in STMC, as is attendance at study groups and other STMC activities planned in the Learning Support Center and other HCC locations.Meetingswith students,parents andthe Coordinator/Counselor, as well as with secondary counselors (the latter primarily for 9th and 10th graders)arecritical in planning and documentingstudents’ progressthrough theprogram.

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC Student Application Forms (8/22/2013)

STMCHCC
Curriculum / STMCvalues tolerance,diversityand inclusiveness.STMCchallenges
studentsto evaluateideas and informationthatare newto them.STMC
preparesstudentstoenterawidersocietythan family and school.
Curriculaare designedtobroadenstudents’understandingof anumber of topics and todeveloptheirskills in criticalthinking.Students can understandaposition oranargumentwithoutsubscribingtoit.
STMCGraduates / STMCstudentslearn howto do the following:
•effectivelyfunctionin acollegeenvironment
•managetheirtime
•organizetheirlivesinandout of school
•negotiatetheirwaythroughproblems
•advocateforthemselves
•reflecton theirexperiencesand continuouslyimprove.
Thiscreatesgraduateswho are preparedfortheworldofworkand/or thecontinuationof theirstudies atafouryearuniversity.
Accreditation / HagerstownCommunityCollege(HCC)is accreditedbytheMiddle States Commission on Higher Education (MSCHE).

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC Student Application Forms (8/22/2013)

DIRECTIONSFORCOMPLETINGTHEENROLLMENTFORMSFOR

FALL2013ADMISSION

STEPONE

Review“WhatisSTEMM Technical Middle College?”,the“AdmissionPolicy”,andthe“AdmissionRequirements”

Package.

STEPTWO

Checktobesurethatyoumeettheadmissionsrequirements.

STEPTHREE

Completetheapplication forms in this packet as well as the separate HCC ESSENCE (STEMM MIDDLE COLLEGE) PROGRAM APPLICATION.Allinformationmustbefilledinandall signaturesobtainedforapplicationtobeconsideredcomplete. Recommendation forms and the student-parent-school-HCC contract are considered to be part of the application. Incomplete applications will be returned and will not be reviewed until they are submitted with all required documents.

STEPFOUR

Usetheenclosedchecklisttoensurethatallpaperworkhasbeencompletedandallsupportingdocuments havebeenenclosed.

STEPFIVE

Writetheenrollmentessayusingthefollowingcriteria:

1-2pagesinlength

Oneinchmarginsonallsides

Doublespaced

12pointfont

Topic:

oWhyisHCCtherightschoolfor me?

oWhatdoI believeIcancontributetoHCC?

STEPSIX

TaketheAccuplacertestattheHCCTestingCenter.

STEPSEVEN

IncludeIEP or 504paperwork,ifapplicable.

STEPEIGHT

Allrequesteddocumentsmustbecompleted (including obtaining your high school principal’s signature) by September 6, 2013 for priority consideration. A limited number of applications may be considered after that date.

QUESTIONS?Call240-500-2412 or send an e-mail to

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

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Student: Pleasecompletethis section beforegiving thisformto yourguidance counselor:

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Student Name:

DateofBirth:

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

High School:

Grade:

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

In referencetothestudentindicated above, pleaseprovidetherequired informationlisted belowdirectlyto theSTMCProgram:

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

__ Applicant’sCumulativeGPA:

__HSA scores, standardizedtest scores, APtest scores

__High School Transcript

__Most recent gradereport

Returnthisform and requested itemsto

(a)HCC STMCProgram

11400 Robinwood Drive

Hagerstown, MD21742

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Student’sattendancerecord: ( ) Excellent( ) Good( ) Fair( ) Poor

Student’smotivation for enrollingin post-secondaryeducation: ( ) High( ) Medium( ) Low

Doesthestudent havelimited English proficiency? ( ) Yes( ) No

Isthis student receiving anyspecialaccommodationsor services? Pleaseexplain.

Inyour opinion,doesthisstudenthaveaneed for academicsupport?Pleasebrieflyexplain.

What isyour perception ofthis student’sacademicpotential? Includeacademic and social factors.

On thebasisofacademicpotential/promise, howwould you recommend thisapplicant?

( ) Highlyrecommend( ) Recommend ( ) Recommend with reservations( ) Do notrecommend

On thebasisofcharacter and personal promise, howwould you recommendthisapplicant?

( ) Highlyrecommend( ) Recommend ( ) Recommend with reservations( ) Do notrecommend

Hasthestudentever beensubject to school disciplinaryaction or suspension? ( )yes( ) no

If yes, pleaseexplain:

GuidanceCounselorName (print)Guidance Counselor SignatureDate

OPERATIONS MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Student: Pleasecompletethis section beforegiving thisformto yourteacher:

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Student Name: High School: TeacherName:

Grade:

Subject(s):

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Thestudentaboveisacandidatefor theHagerstownCommunityCollegeSTMCProgram. Pleasecompletethisform and return itto thehigh school counselor working with this student ordirectlyto our office.

Pleasedescribethis student’s academicstrengthsandweaknesses:

Returnthisformto

(a)HCC STMC

11400 Robinwood Drive

Hagerstown, MD21742

On thebasisofacademicpotential, how would yourecommend thisapplicant?

( ) Highlyrecommend( ) Recommend ( ) Recommend with reservations( ) Do notrecommend

On thebasisofcharacter and personal promise, howwould you recommendthisapplicant?

( ) Highlyrecommend( ) Recommend ( ) Recommend with reservations( ) Do notrecommend

TeacherName (print)Teacher SignatureDate

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

LAST NAME:

FIRSTNAME:

STUDENT-PARENT-SCHOOL-HCC CONTRACT

Student and parent/guardian should sign and date this form before admission. If the student is admitted to the STMC, school and college officials will sign and date the appropriate lines and will send a completed copy of this form to the student’s address as listed on the application.

MIDDLE COLLEGE HIGH SCHOOL STUDENT ENROLLMENT CONTRACT

If I am accepted to attend STMC,I agree to all of the following expectations:

• Be punctual and maintain good attendance in all classes.
• Take responsibility for my own learning,behavior,and success.
• Devote a minimum of two hours each evening to homework, studying and
• reading.
• Behave in a manner that shows respect for the college, school facilities, and
• equipment.
• Understand that my existence on the college campus is a privilege, not a
• right.
• Demonstrate the ability to make mature, independent, productive choices,
• and accept responsibility for those choices.
• Complete all high school graduation requirements.
• Plan to complete at least 30 college credits.
• Understand that I may be referred to some other program if I do not maintain a 2.5 grade point average (GPA) in high school and college classes.

StudentSignatureDate

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

MIDDLE COLLEGE HIGH SCHOOL PARENTAL ENROLLMENT CONTRACT

If my child is accepted,I agree to all of the following expectations:

• Provide a minimum of two hours each evening for my child to do homework, studying, and reading.
• Ensure that my child has transportation to get to school on time and to get home in a timely manner.
• Support daily attendance; call the school on any day of an absence.
• Schedule all family vacations when school is not in session.
• Attend and participate in parent/school functions.
• Keep up on STMC activities by reading all material sent home and visiting the Web site at hagerstowncc.edu.
• Understand that my child may be referred to some otherprogram if he or she does not maintain a 2.5 grade point average in high school and college classes.

Parent-GuardianSignatureDate

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

SECONDARY SCHOOL STUDENT ENROLLMENT CONTRACT

If the student named above is accepted to the STMC, WCPS agrees to do the following:

• Award high school credit for college courses taken via the STMC as agreed upon by WCPS and HCC.
• Provide guidance to the student during his or her ninth and tenth grade year to ensure that he or she takes high school classes needed to prepare for STMC work.
• Allow the student named above to participate in extracurricular activities at WCPS as appropriate.
• Allow the student named above to participate in his or her “home” high school’s graduation ceremony.
• Share student data necessary for STMC enrollment and evaluation with HCC.

School OfficialSignatureDate

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

HAGERSTOWN COMMUNITY COLLEGE/STMC ENROLLMENT CONTRACT

If the student named above is accepted to the STMC, HCC agrees to do the following:

• Provide high-quality staff and faculty who know their subject matter and who understand the psychosocial development and make-up of young adults.
• Provide a positive, constructive, and academically rigorous learning environment.
• Provide information about the Free Application for Federal Student Aid (FAFSA) and other financial aid opportunities, such as S-STEM scholarships, to students.
• Provide financial aid and advising services to students.
• Provide tutoring to students in the Learning Support Center.
• Award college credit to the student for courses successfully completed.
• Advise the student regarding program completion plans and career and transfer opportunities.

_ HCC Official Signature Date

LAST NAME: FIRSTNAME:

AFFIRMATIONOFCITIZENSHIPFORM

Checkthecorrectresponsesand answerall pertinent questions.Includephotocopiesof allrequested documents.

Areyoua citizenoftheUnitedStates?

YES1.Signanddatethisformbelow.

2.Proceedtothenextform.

NO1. What is your country of citizenship?

2.Areyoua residentalien?

_ YES1.Makea copyofbothsidesofyourResidentAlienCard(greencard)andplaceit inthe backinsidepocketoftheenrollmentfolder,ORmakea copy oftheI-551 stampinyour passport,showingthatthisstatuswasgrantedatleastsixmonthsago.

2.Signanddatethisformbelow.

3.Proceedtothenextform.

_NO

AreyouintheUnitedStatesonanF-1Visa?(StudentVisa)

_ YES1.YouarenoteligibletoattendSTMC.STMCisnotauthorizedtoissueastudentvisa

(I-20).

_NO

AreyouintheUnitedStatesona J-1Visa?(Exchangevisitorvisa)

_ YES1.YouarenoteligibletoattendSTMC.

_NO

Ifyouarenota citizenoftheUnitedStatesbutareintheU.S.:

1.Indicatethetypeofvisathatyouhold. _

2.Inthebackinsidepocketoftheenrollmentfolder,placea copyof:

a)Passportwithphoto,dateofpassportissue,anddateof passportexpiration

b)I-94cardwithproofof status

c) Copyofvisawithphoto,dateofissue,anddateofexpiration

3.Signanddatethisformbelow.

4.Proceedtothenextform.

Putcopiesofallrequesteddocumentsinthebackinsidepocketoftheadmissionpacket.Signyournamebelow,date theform,andcontinuewiththeadmissionpacket.

StudentSignatureDate

_ Parent/GuardianSignature Date

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

LAST NAME:

FIRSTNAME:

AFFIRMATIONOF PRIORDISCIPLINERECORD

Awillfulfalsestatementonthisaffirmation willresultindenialof entryorremovalfrom STMC.

Haveyoueverbeen suspended? NoYes

Haveyoueverbeenexpelled?NoYes

Pleasereadtheparagraphsbelowandfillouttheappropriateonetomatchtheanswerslistedabove.

.

ParagraphI:Ihavenever been suspendedor expelled

Theundersignedaffirmsthat hasnotbeensuspendedorexpelledfromanypublicor privateschoolinMarylandoranyotherstateforanoffenseinvolvingweapons, arson,alcohol,drugs,orforthe willfulinflictionofinjurytoanotherpersonorforanyactofviolenceagainstpersonsand/orpropertycommittedon schoolpremises,atanyschool-sponsoredactivity,orona publicorprivateconveyanceprovidingtransportationto andfroma schoolorschool-sponsoredactivity.

DateSignatureofStudent

DateSignatureofParent/Guardian

Paragraph2:Ihavebeensuspendedorexpelled

Theundersignedaffirmsthat hasbeensuspendedorexpelledfromapublicor privateschoolinMarylandoranotherstateforanoffenseinvolvingweapons,arson,alcohol,drugs,orforthewillful inflictionofinjurytoanotherpersonorforanyactofviolenceagainstpersonsand/orpropertycommittedonschool premises,atanyschool-sponsoredactivity,orona publicorprivateconveyanceprovidingtransportationtoandfrom a schoolorschool-sponsoredactivity.

Explainthecircumstancesindetailonthebackofthisform.Includetheschoolname,datesofsuspensionor expulsion,anda descriptionoftheincidentthatresultedinthesuspensionorexpulsion.PleasenotethatSTMC willcontacttheschooltoconfirmtheinformationprovidedisaccurate.

DateSignatureofStudent

DateSignatureofParent/Guardian

Discipline Record

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

LASTNAME:______

FIRSTNAME: ______

STATEMENTOFELIGIBILITYFOREDUCATIONALSUPPORTSERVICES

Haveyoueverhadan IEP?YesNo

Do currentlyhaveanIEP?YesNo



Ifyestoeitherquestion,youmustprovideSTMCwithcopiesofthe followingdocuments:

CurrentIndividualizedEducationProgramReport

InitialIEPreport

Additionalorrecentreports/evaluations

Pleaseincludetheseformsinthefrontpocketofthisadmissionfolder.

Haveyoueverreceived servicesunderSection504?YesNo

Do youcurrentlyhavea504 Plan?YesNo





Ifyestoeitherquestion,youmustprovideSTMCwithcopiesofthe followingdocuments:

InitialSection504EvaluationReport.

Current504AccommodationPlan

Additionalorrecentreports/evaluations

Pleaseincludetheseformsinthefrontpocketofthisadmissionfolder.

If youhavehadeducationalaccommodationsin thepast, do youanticipateusingthematSTMC?

YesNo

If so, pleaseprovidean IEPor504plan.

If youhavehadaccommodations inthe past, butwillnotbeusingthem;please describewhyserviceswillnotbe needed,onthereverseside ofthis page.

LASTNAME:

FIRSTNAME:

HOMELANGUAGESURVEY

TheSTEMM Technical MiddleCollegeSchoolDistrictiscollectinginformationregardingthe languagebackgroundofeach ofitsstudents.Thisinformationwillbeusedby STMC to determinethenumberofstudentswho should be providedbilingualinstruction.

Wouldyoupleasehelp byprovidingthefollowinginformation?

STEMM Technical Middle CollegeGradeforFall2013:

NameofStudent: Age:

1. Is English thefirstlanguage thestudent learned?

YesNoIfYes,pleasegotothenext form.

Ifno,what isthelanguage?

Howmany yearshasthestudent been speaking English?

2.Is the primarylanguage spokenin yourhomealanguageotherthanEnglish?

YesNo

What isthelanguage?

Dateof Immigration: City,Country:

3.Hasyourchildeverbeen testedfor,or completedclassesin, EnglishasaSecond

Language(ESL) in previousschool(s)?YesNo

Signatureof ParentorGuardian:

*“Primarylanguage”meansthedominantlanguage used byparents/guardiansfor communication.

LASTNAME:

FIRSTNAME:

STATEMENTOFTRUTHANDACCURACYFORM

I certifythatallstatementsand formssubmittedas part ofthisenrollmentpacketaretrueand accurate.Thestatementsand theformsareprovidedforthepurposeof enrollingin STEMM Technical MiddleCollege.I understandthatFALSE statementsmayresultin denial ofadmission totheSTEMM Technical MiddleCollege or exclusionfromtheprogram.

Student SignatureDate

ParentSignatureDate

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

LAST NAME: FIRSTNAME:

STUDENTINFORMATION

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Sibling

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Nameofsibling attendingSTMC

CurrentGradeLevel: Grade9 Grade10 Grade11 Grade12

StudentName:

LastFirstMiddle

Street Address:

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

City:

State:

Zip:

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

*HomePhone:

StudentCellPhone:

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

CountyofResidence:

Numberofyearsstudent haslived incounty?

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1

Isthisstudent Hispanic/Latino?(chooseonlyone) / Whatisthestudent’srace?(Selectoneormore)
No,not Hispanic orLatino
Yes,HispanicorLatino / American Indianor Alaskan Native
Asian American
BlackorAfrican American
NativeHawaiian orPacific
White

Student’sSchoolDistrictofResidence:

High School attended,Grade9:

High School attended,Grade10: (if applicable)

PreviousAttendanceatHagerstown Community College: Have you everenrolled in,applied to,orattended classesatHagerstown Community College? Yes No

STMC MANUAL APPENDIX A: STUDENT APPLICATION FORMS 1