ECHS application 2012

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                 Robeson Early College High School                                      photo
                         at Robeson Community College
                                                                                         here
             5170 Fayetteville Road Lumberton, North Carolina 28360

                                                                                       REQUIRED
                    APPLICATION FOR ADMISSION

Student’s Name:
Last___________________________First_______________________MI______
NCWise Number: _________________Current School: _____________________
Sex: Male_____ Female_____ Birthday: Month_______ Day_____ Year______
Mailing Address:______________________City:___________State:___ Zip:____
Physical Address:_____________________ City:___________State:___ Zip:____
Home Telephone Number:_________________
Ethnicity/Race: (Please check one)
       American Indian/ Alaska Native____ Asian/Pacific Islander____ Black____
       Hispanic____ White____ Multiracial____ Other:____
Please check one: Free lunch___ Reduced lunch___ Paid lunch___
The student lives with: Both parents____ Father____ Mother____
              Grandparent____ Guardian______
Parent / Guardian Information:
Name(s) of Parent (s) or Guardian:
Last___________________________First_____________________________
Mailing Address (if different from student):______________________________
Parent Work Number:________________Parent Cell Number________________
Parent Work Number:________________Parent Cell Number________________
Mother’s Educational Level: (circle last grade completed) 8 9 10 11 12 13 14 15 16 +
Father’s Educational Level: (circle last grade completed) 8 9 10 11 12 13 14 15 16 +
INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED FOR ADMISSION!
APPLICATION IS DUE TO EARLY COLLEGE HIGH SCHOOL
NO LATER THAN MARCH 8, 2012. (Applications will be kept on file for one (1) year.)
                       Robeson Early College High School
                               at Robeson Community College
                   5170 Fayetteville Road Lumberton, North Carolina 28360



                                                      STUDENT PROFILE
NAME: _________________________________________

THIS IS NOT A TEST! THERE ARE NO RIGHT OR WRONG ANSWERS!
We are interested in learning more about you, your interests and your personal academic goals.
Please answer the following questions listed below and tell us about yourself.
This is an opportunity to express in your own words, who you are and what is important to you.

Write three words that best describe you.

1. _______________________     2. ______________________      3. _____________________

Which academic subjects interest you the most? Why?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

What do you believe are your academic weaknesses?

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

*********************************************************************************************

Please rate yourself in the following areas compared to students in your grade.

                       Outstanding            Good                Average           Below Average
Leadership
Self-confidence
Independence
Trustworthy
Disciplined
Self-starter
                        Robeson Early College High School
                                at Robeson Community College
                    5170 Fayetteville Road Lumberton, North Carolina 28360



                                                PARENT STATEMENT

Applicant’s Name: ____________________________________

Name of parent completing this form: ___________________________________

What are your expectations for your child’s education?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


Please comment on your child’s academic strengths and weaknesses.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


What do you see as the advantage of an Early College High School for your child’s high school career?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
                          Robeson Early College High School
                                  at Robeson Community College
                      5170 Fayetteville Road Lumberton, North Carolina 28360



                                                    PARENT STATEMENT

How do you view your child’s ability to have healthy peer- to- peer and student- to- instructor
relationships?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please comment on any personal setbacks, difficulties and / or medical issues that your child has
experienced that we should be made aware of.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Your input regarding your child is important to us. If there is any additional information that you would
like us to know about your child, please state it at this time.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Is your child participating in any high school classes online? If so which one(s)_____________________________
_____________________________________________________________________________________________
Is your child an English as a Second Language Learner (ESL)? Yes ______     No_______
Is your child in the Exceptional Children’s Program (EC)? Yes________    What area _____________No________
Does your child have a 504?   Yes _____   No ______




NAME OF PARENT/ GUARDIAN (Please Print): ________________________________________________


Parent/ Guardian Signature: _____________________________________ Date: ________________
                          Robeson Early College High School
                                  at Robeson Community College
                      5170 Fayetteville Road Lumberton, North Carolina 28360


                                                            GUIDANCE FORM

Applicant Name: _______________________________ NC Wise Number: _______________________
Applicant Social Security Number: ______________________
Applicant traditional high school assigned: __________________________________________________
        The following information will be utilized to assist in determining student enrollment.

1. Is this student AIG? Yes________ Math_____ Reading____ No________

2. Does this student receive ESL services           Yes________ No _______

3. Is this student EC?    Yes_______ (area of exceptionality________________) No _____

  Does the student have a 504? Yes_____(area of exceptionality________________) No _____

4. Have there been discipline referrals? Yes_________ No ________

If yes, please explain ________________________________________________________

__________________________________________________________________________

Have there been any out of school suspensions? Yes_______ No _______

If yes, please explain ________________________________________________________

__________________________________________________________________________


                                        TESTING INFORMATION

7th Grade EOG Scores: Math___________               Level _________
                      Reading ________              Level _________

I verify that the information listed is true and accurate to the best of my ability.

Signature: ______________________________________________ Date: _______________

Name printed: __________________________________________ Title: _______________

****PLEASE ATTACH A COPY OF THEIR LAST REPORT CARD
****PLEASE ATTACH A COPY OF THEIR ATTENDANCE SUMMARY
                                         Robeson Early College High School
                                            at Robeson Community College
                                5170 Fayetteville Road Lumberton, North Carolina 28360


                                                                        RECOMMENDATION


To the person making the recommendation: Early College High School has a rigorous college
preparatory program curriculum. With this in mind, please complete the form below. This form will
remain confidential and will not become part of the student’s permanent record. We sincerely appreciate
your cooperation and candor. This form must be returned in a sealed envelope with the
recommender’s signature sealing the back.

Applicant Name: _______________________________                                    NCWISE # ______________________
Current School: ________________________________
Recommendation By: ____________________________ (please print) Position: ________________
How long have you known the student? ________________________

                                                      Academic Qualities
                                          Below Average                 Average          Good      Excellent
Study Habits
Attention Span
Ability To Work Independently
Ability to Organize
Motivation
Intellectual Curiosity


                                                          Personal Qualities
                                          Below Average                  Average         Good      Excellent
Academic Commitment
Creativity
Self-Confidence
Leadership Potential
Reaction to Criticism
Concern for Others
Personal Conduct
Personal Integrity
Ability to Act Independently
Ability to Work Cooperatively
Level of Maturity
Sense of Humor

Please provide examples of this student’s academic / personal qualities that may help us in our decision
making process:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
                                         Robeson Early College High School
                                            at Robeson Community College
                                5170 Fayetteville Road Lumberton, North Carolina 28360


                                                                        RECOMMENDATION


To the person making the recommendation: Early College High School has a rigorous college
preparatory program curriculum. With this in mind, please complete the form below. This form will
remain confidential and will not become part of the student’s permanent record. We sincerely appreciate
your cooperation and candor. This form must be returned in a sealed envelope with the
recommender’s signature sealing the back.

Applicant Name: _______________________________                                    NCWISE # ______________________
Current School: ________________________________
Recommendation By: ____________________________ (please print) Position: ________________
How long have you known the student? ________________________

                                                      Academic Qualities
                                          Below Average                 Average          Good      Excellent
Study Habits
Attention Span
Ability To Work Independently
Ability to Organize
Motivation
Intellectual Curiosity


                                                          Personal Qualities
                                          Below Average                  Average         Good      Excellent
Academic Commitment
Creativity
Self-Confidence
Leadership Potential
Reaction to Criticism
Concern for Others
Personal Conduct
Personal Integrity
Ability to Act Independently
Ability to Work Cooperatively
Level of Maturity
Sense of Humor

Please provide examples of this student’s academic / personal qualities that may help us in our decision
making process:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
                         Application Instructions
1.   Make sure every question is answered
2.   Please make sure parent has signed and dated the bottom of page 4
3.   School counselor is required to fill out the guidance form
4.   Counselors check that the student has turned in 2 letters of recommendation in
     envelopes that are sealed and signed by the person making the recommendation
5.   School counselor needs to double check the application is complete by verifying
     all answers are filled in and you have attached a copy of their last report card
     and their attendance summary before taking them to Early College
6.   Pictures are required
7.   Please note that if something is requested on the application than it is required!
8.   Incomplete applications only delay processing
9.   It is preferred that all applications from a middle school be brought by the
     counselor at one time.

     ×Please note that unfortunately not everyone gets an interview and not
     everyone who gets an interview gets accepted.
     ×Phone calls for interviews will happen the first week of April
     ×Interviews will be conducted the April 23rd to April 27th
     ×Notification for acceptance (or otherwise) will come in the mail around June
     10th
     ×School begins the first week of August

				
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