Grassfield High School Form – Fill Out and Use This PDF

GRASSFIELD HIGH SCHOOL

GOVERNOR’S STEM ACADEMY APPLICATION

Grassfield High School, 2007 Grizzly Trail, Chesapeake, VA 23323

Application Deadline: January 15 -- Submit to middle school counselor.

STUDENT DATA SHEET

________________________________________________________________________________________________________________

Student’s Legal Last Name Legal First Name Middle Name Preferred Name

____________________________________________________________________________________________

Student’s Residence – Street Address		City	State	Zip Code
_______________________________________________		__________	_________________________
Current Middle School		Grade Level	Student ID Number
Birth Date ___________________________ Gender (M or F) __________
__________________________________________		___________________________________________
Mother’s/Guardian’s Name		Father’s/Guardian’s Name
Home Telephone # ____________________	E-mail Address _________________________________________
Mother’s Work #______________________	Mother’s cell # _________________________________________

Father’s Work # _______________________ Father’s cell # __________________________________________

Student’s Zoned High School (if not accepted for Governor’s STEM Academy)

_________________________________

Student Essay – Directions to Student

On a separate sheet of paper neatly print or type a thoughtful essay of approximately 350 words that describes your goals for participating in the Governor’s STEM Academy. The essay should include your thoughts and reasons for which of the three career pathways you wish to focus your studies: programming and software development, marketing management, or engineering and technology. Essays should be original, creative and grammatically correct.

The Chesapeake Public School system is an equal educational opportunity school system. The School Board of the City of Chesapeake also adheres to the principles of equal opportunity

in employment and, therefore, prohibits discrimination in terms and conditions of employment on the basis of race, sex, national origin, color, religion, age, or disability.

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

ADMISSIONS AGREEMENT

The Governor’s STEM Academy at Grassfield High School offers a specialized curriculum for highly interested and motivated students. For a student to be successful in this program, he/she must be a consistent, dedicated learner. Therefore, applicants and parents are required to make the following commitment.

I agree to the following terms and conditions for participating in the Grassfield Governor’s STEM Academy.

Iwill

1.follow the rules of the school as outlined in the Grassfield High School Student Handbook.

2.actively participate in each class by being prepared, listening attentively, offering relevant comments, posing insightful questions, taking notes, and doing any other activities necessary to meet the expectations set forth for each class.

3.submit quality work in a timely fashion seeking additional assistance from my instructors as needed.

4.manifest the highest degree of academic integrity. Incidents of cheating may be grounds for removal from the program.

5.maintain an excellent attendance record, scheduling appointments or vacations at times that do not conflict with classes.

6.remain in the program unless recommended for dismissal by the academy coordinator or academy staff. Recommendation for continuance or dismissal from the program will be determined by student progress, attitude, and motivation.

I understand that if I do not meet the standards of the academy program, either because of the quality of my work or because of my performance as a serious learner, I may be asked to withdraw from the program to enroll in a course of study which better meets my level of performance. I also understand that if I leave the academy program, I must return to my zone high school and, according to Virginia High School League rules, I would not be eligible to participate in VHSL activities for 365 days unless I was granted a waiver under VHSL rule 28-6-2(14).

On my honor I pledge that this work is completely from my own effort.

______________________________________	_______________
Student’s Signature	Date

I hereby grant permission and consent for my son/daughter to enroll in the Grassfield Governor’s STEM Academy program and agree to all terms listed above. Finally, I will support my child’s academic growth and encourage development of independent study skills.

______________________________________	________________
Parent’s/Guardian’s Signature	Date

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

PARENT ASSESSMENT FORM

Student’s Name____________________________________________________________________

Counselor______________________________________ School____________________________

Directions to the Student: Complete the information above and have a parent or guardian complete this form.

Directions to the Parent: Your child is applying for admission to the Governor’s STEM Academy program at Grassfield High School. For each item below, please place a check mark in the box that best describes your assessment of your child.

	Almost	Often	Occasionally	Rarely	Never
	Always

Ease of Learning – Enjoys the challenge of problems, assignments, and issues. Learns quickly.

Adaptability – Approaches ideas and problems from a number of directions. Finds alternative means of solving problems. Thinks about ideas in new ways.

Initiative and Enthusiasm – Is a highly motivated, independent worker. Seeks additional tasks; is intellectually curious; stays actively engaged in activities.

Persistence – Stays with tasks; relates progress on tasks to accomplishment of larger goals.

Reliability and Integrity – Is scrupulous and punctual in fulfilling obligations; readily takes responsibility.

Reasoning – Uses logical, analytical reasoning and/or creative, divergent thinking to consider ideas or solve problems. (Originality and elaboration of thinking)

Communications – Communicates effectively.

Organization – Manages time, resources and materials; meets deadlines; divides tasks into subtasks.

Leadership Qualities – Shows respect and tolerance of others’ views. Is willing to accept the ideas of others and contributes to the group process. Influences others in a positive manner.

Success – Displays the ability to succeed in a challenging program.

OVER

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Student’s Name____________________________________________________________________

Counselor______________________________________ School____________________________

Please provide any comments that might assist us in determining your child’s potential to succeed in the Governor’s STEM Academy program.

_______________________________	_______________________________	______________
Parent’s Name (Printed)	Parent’s Signature	Date

Thank you for completing this form. Your input is valued.

Please return this form to your child’s school counselor.

Due Date: January 15, 2013

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

SCIENCE TEACHER RECOMMENDATION FORM

Student’s Name ______________________________________________________________________________

Teacher _____________________________________	Subject______________________________________
Counselor___________________________________	School_______________________________________

Directions to Student: Complete the information above and give a separate form to the following four teachers

for recommendation: your current English teacher, math teacher, science teacher, and social studies teacher.

Directions to Student, Parent/Guardian: Teacher recommendations are confidential; please do not ask teachers to reveal the contents to your son/daughter or to you.

Directions to Teacher: The student whose name appears above is applying for admission to the Governor’s STEM Academy at Grassfield High School. For each item below, please mark the box that best represents your assessment of this student.

	Almost	Often	Occasionally	Rarely	Never
	Always

Ease of Learning – Enjoys the challenge of problems, assignments, and issues. Learns quickly.

Adaptability – Approaches ideas and problems from a number of directions. Finds alternative means of solving problems. Thinks about ideas in new ways.

Initiative and Enthusiasm – Is a highly motivated, independent worker. Seeks additional tasks; is intellectually curious; stays actively engaged in activities.

Persistence – Stays with tasks; relates progress on tasks to accomplishment of larger goals.

Reliability and Integrity – Is scrupulous and punctual in fulfilling obligations; readily takes responsibility.

Reasoning – Uses logical, analytical reasoning and/or creative, divergent thinking to consider ideas or solve problems. (Originality and elaboration of thinking)

Communications – Communicates effectively.

Organization – Manages time, resources and materials; meets deadlines; divides tasks into subtasks.

Leadership Qualities – Shows respect and tolerance of others’ views. Is willing to accept the ideas of others and contributes to the group process. Influences others in a positive manner.

Success – Displays the ability to succeed in a challenging program.

OVER

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

MATH TEACHER RECOMMENDATION FORM

Student’s Name ______________________________________________________________________________

Teacher _____________________________________	Subject______________________________________
Counselor___________________________________	School_______________________________________

Directions to Student: Complete the information above and give a separate form to the following four teachers

for recommendation: your current English teacher, math teacher, science teacher, and social studies teacher.

Directions to Student, Parent/Guardian: Teacher recommendations are confidential; please do not ask teachers to reveal the contents to your son/daughter or to you.

Directions to Teacher: The student whose name appears above is applying for admission to the Governor’s STEM Academy at Grassfield High School. For each item below, please mark the box that best represents your assessment of this student.

	Almost	Often	Occasionally	Rarely	Never
	Always

Ease of Learning – Enjoys the challenge of problems, assignments, and issues. Learns quickly.

Adaptability – Approaches ideas and problems from a number of directions. Finds alternative means of solving problems. Thinks about ideas in new ways.

Initiative and Enthusiasm – Is a highly motivated, independent worker. Seeks additional tasks; is intellectually curious; stays actively engaged in activities.

Persistence – Stays with tasks; relates progress on tasks to accomplishment of larger goals.

Reliability and Integrity – Is scrupulous and punctual in fulfilling obligations; readily takes responsibility.

Reasoning – Uses logical, analytical reasoning and/or creative, divergent thinking to consider ideas or solve problems. (Originality and elaboration of thinking)

Communications – Communicates effectively.

Organization – Manages time, resources and materials; meets deadlines; divides tasks into subtasks.

Leadership Qualities – Shows respect and tolerance of others’ views. Is willing to accept the ideas of others and contributes to the group process. Influences others in a positive manner.

Success – Displays the ability to succeed in a challenging program.

OVER

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

ENGLISH TEACHER RECOMMENDATION FORM

Student’s Name ______________________________________________________________________________

Teacher _____________________________________	Subject______________________________________
Counselor___________________________________	School_______________________________________

Directions to Student: Complete the information above and give a separate form to the following four teachers

for recommendation: your current English teacher, math teacher, science teacher, and social studies teacher.

Directions to Student, Parent/Guardian: Teacher recommendations are confidential; please do not ask teachers to reveal the contents to your son/daughter or to you.

Directions to Teacher: The student whose name appears above is applying for admission to the Governor’s STEM Academy at Grassfield High School. For each item below, please mark the box that best represents your assessment of this student.

	Almost	Often	Occasionally	Rarely	Never
	Always

Ease of Learning – Enjoys the challenge of problems, assignments, and issues. Learns quickly.

Adaptability – Approaches ideas and problems from a number of directions. Finds alternative means of solving problems. Thinks about ideas in new ways.

Initiative and Enthusiasm – Is a highly motivated, independent worker. Seeks additional tasks; is intellectually curious; stays actively engaged in activities.

Persistence – Stays with tasks; relates progress on tasks to accomplishment of larger goals.

Reliability and Integrity – Is scrupulous and punctual in fulfilling obligations; readily takes responsibility.

Reasoning – Uses logical, analytical reasoning and/or creative, divergent thinking to consider ideas or solve problems. (Originality and elaboration of thinking)

Communications – Communicates effectively.

Organization – Manages time, resources and materials; meets deadlines; divides tasks into subtasks.

Leadership Qualities – Shows respect and tolerance of others’ views. Is willing to accept the ideas of others and contributes to the group process. Influences others in a positive manner.

Success – Displays the ability to succeed in a challenging program.

OVER

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

SOCIAL STUDIES TEACHER RECOMMENDATION FORM

Student’s Name ______________________________________________________________________________

Teacher _____________________________________	Subject______________________________________
Counselor___________________________________	School_______________________________________

Directions to Student: Complete the information above and give a separate form to the following four teachers

for recommendation: your current English teacher, math teacher, science teacher, and social studies teacher.

Directions to Student, Parent/Guardian: Teacher recommendations are confidential; please do not ask teachers to reveal the contents to your son/daughter or to you.

Directions to Teacher: The student whose name appears above is applying for admission to the Governor’s STEM Academy at Grassfield High School. For each item below, please mark the box that best represents your assessment of this student.

	Almost	Often	Occasionally	Rarely	Never
	Always

Ease of Learning – Enjoys the challenge of problems, assignments, and issues. Learns quickly.

Adaptability – Approaches ideas and problems from a number of directions. Finds alternative means of solving problems. Thinks about ideas in new ways.

Initiative and Enthusiasm – Is a highly motivated, independent worker. Seeks additional tasks; is intellectually curious; stays actively engaged in activities.

Persistence – Stays with tasks; relates progress on tasks to accomplishment of larger goals.

Reliability and Integrity – Is scrupulous and punctual in fulfilling obligations; readily takes responsibility.

Reasoning – Uses logical, analytical reasoning and/or creative, divergent thinking to consider ideas or solve problems. (Originality and elaboration of thinking)

Communications – Communicates effectively.

Organization – Manages time, resources and materials; meets deadlines; divides tasks into subtasks.

Leadership Qualities – Shows respect and tolerance of others’ views. Is willing to accept the ideas of others and contributes to the group process. Influences others in a positive manner.

Success – Displays the ability to succeed in a challenging program.

OVER

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

REQUIRED ELECTRONIC PORTFOLIO

To be considered for acceptance into the Governor’s STEM Academy at Grassfield High School, each applicant must complete an electronic portfolio containing three activities that demonstrates his/her ability in the field of technology.

Directions:

Save your work to a recordable CD (CD-R) using the following guidelines:

Create a folder with your student ID number as the name.

Within this folder, save each completed activity in a separate folder.

Complete three of the eight activities listed below.

. Include CD with your application and save a back-up copy for yourself.

Examples of Student Products for the Electronic Portfolio

1.Create a 5-minute, self-running multimedia presentation that markets either tourism for the Commonwealth of Virginia or a college athletic program. Self-running describes a program that will run on its own. Suggested software: Microsoft PowerPoint or Microsoft Movie Maker

2.Create a newsletter (no more than four pages) on international issues. Integration of proper grammar and formal diction are expected to be evident in the product. No copied or pasted content accepted and the product must be the student’s original work.

Suggested software: Microsoft Publisher or Microsoft Word

3.Create a website for your own school that can be viewed with Internet Explorer. There should be a Home Page with four additional linked pages. Copies of the school’s existing web page will not be accepted. Suggested software: Microsoft Publisher, Microsoft Word, or any other program that will save in *.html format.

4.Create a technical guide (pamphlet, brochure, or multimedia presentation) that explains to novice users how to analyze and solve simple hardware and software problems. Consider problems such as “a job won’t print” or “the computer won’t turn on.”

Suggested software: Microsoft PowerPoint, Microsoft Publisher, Microsoft Word

5.Create an original resume that would reflect the accomplishments of the student applicant. Suggested software: Microsoft Word

6.Create a floor plan design of a business office of 12-15 employees.

Any entry not saved in the suggested format will not be evaluated.

Suggested software: AutoCAD or any program that will save in *.bmp, *.jpg, *.gif, * .pdf, or *.wmf format

7.Create a working database for a business such that five employees can enter sales from four products sold (video games, CDs, books, and DVDs). Employees should also be able to track sales by product type or by employee. Enter sufficient data so that the database can be queried.

Suggested software: Microsoft Access

8.Create a project proposal that details what is necessary to establish a networked environment for every room in a house. Consider at least one file server and two printers in your proposal.

Any entry not saved in the suggested format will not be evaluated. Suggested software: Microsoft Word

If including floor plans, AutoCAD or any program that will save in *.bmp, *.jpg, *.gif, *.pdf, or *.wmf format

Submit your CD containing your electronic portfolio with your academy application by January 15, 2013 to your school counselor. Your application will not be considered without the electronic portfolio. Please note that the electronic portfolio cannot be returned to the applicant.

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GRASSFIELD HIGH SCHOOL GOVERNOR’S STEM ACADEMY

COUNSELOR CHECKLIST

Student’s Name _________________________________________ Grade Level________________

Current

School______________________________________________________________________________

Directions to Student: Supply the information requested above and give this form to your school counselor along with completed items 1, 2, 3, 8, and 10 (list below) by January 15, 2013.

Directions to School Counselor: The final deadline for the student to submit all items to you is January 15, 2013. Please assemble the student’s application using the checklist below, make copies if necessary, and forward the entire packet to the Academy Coordinator at Grassfield High School.

Applications received after January 15, 2013 will not be considered in the first round of acceptances. Late applications will be placed on the academy waiting list to be considered if any vacancies occur. Before forwarding any late applications, please clearly mark the top of the first page with “late” and indicate the date received.

INFORMATION BELOW TO BE COMPLETED BY THE SCHOOL COUNSELOR

Application Checklist

______	1.	Student Data Sheet (Page 1)
______	2.	Admissions Agreement (Page 2)
______	3.	Parent’s Assessment Form (Pages 3 & 4)
______	4.	Teacher’s Recommendation Form #1 (Pages 5 & 6)
______	5.	Teacher’s Recommendation Form #2 (Pages 7 & 8)
______	6.	Teacher’s Recommendation Form #3 (Pages 9 & 10)
______	7.	Teacher’s Recommendation Form #4 (Pages 11 & 12)
______	8.	Applicant’s Electronic Portfolio of three activities (CD)
______	9.	Counselor’s Checklist (Page 14)
______	10.	Student Essay on separate sheet of paper provided by student (Directions on Page 1)

Counselor’s signature_______________________________________ Date___________________

Note: Applicants’ transcripts will be used in screening applicants, but the information will be obtained directly from the Chesapeake Public Schools Information Technology Department. The counselor need not supply this information with applications.

Thank you for assisting in the completion of this student’s application packet.

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