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									                                                                                                                            2011 Application for Admission




                                                The Houston Academy for International Studies
                                                    An Exemplary Early College High School
                                       1810 Stuart• Houston, TX 77004 • School: 713-942-1430 •Fax: 713-942-1433
                                                               www.houstonais.org

The HOUSTON ACADEMY FOR INTERNATIONAL STUDIES is an HISD charter high school created in collaboration with the
Houston A+ Challenge, Asia Society Network for International Studies Schools and Houston Community College Central
Campus. This school offers students a small school environment, a focus on international studies and the opportunity to
                                                                                                 th
take HCC courses and earn college credit while in high school. We will accept approximately 100 9 Grade students for the
2011-2012 school year.


Section I. Applicant Information
Last Name                                  First Name                                 Middle Initial
                                                                                                                                       Male             Present Grade level
                                                                                                                                       Female
Current School (Middle School/High School)
                                                                                                                                  Zoned School


Birthday (mm/dd/year)                     Social Security Number or Student ID #                                                  E-mail Address
                                          __ __ __ - __ __ - __ __ __ __ Student ID # ________

Please check one: OPTIONAL
    Hispanic                           African American                             Asian or Pacific Islander                               White
    Other (Please Specify) __________________________________________________________




Section II: Parent Contact Information
Last Name                                                       First Name                                      Relationship



Address                                                                     City                                State                                    Zip

Home Phone                                                                  Work Phone                                                Cell


Parent /Guardian E-mail                                                     How did you hear about Houston Academy for International
                                                                            Studies?

List the name(s) of the person/people and relationship with whom the student resides:



Does your mother or your father have a college degree?                                                  Yes              No

Do you receive free or reduced lunch at your current school?                                            Yes              No



It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national origin, marital status, race
                                                                                                                                                                                      1
religion, sex, veteran status or political affiliation in its education or employment programs and activities, as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Educational Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
                                                                                                                            2011 Application for Admission


Section III. Applicant/Student Response

Please answer the following questions in your own handwriting.

      1. Why do you want to attend the Houston Academy for International Studies High School?




      2. Represent yourself below (write, draw, collage, website, etc.) Attach additional page if needed.




      3. What do you want your high school experience to entail (academics, extra-curricular, student
         government)? Describe the perfect high school in which you would be successful?




      4. In your eyes, what will it take to be successful in college? Which college do you want to attend? Why?




It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national origin, marital status, race
                                                                                                                                                                                      2
religion, sex, veteran status or political affiliation in its education or employment programs and activities, as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Educational Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
                                                                                                                            2011 Application for Admission


Section IV. Parent/Guardian Perspective

Please respond fully to the following questions.

      1. Why would you want your child to attend the Houston Academy for International Studies?




      2. What are your hopes for your child’s future?




      3. Describe an event in the educational experience of your child that impacted their academic growth.




      4. List ways you provide support for your child and assist in his/her education.




      5. Please comment on your child’s relationship with teachers and mentors who have influenced his/her
         development.




It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national origin, marital status, race
                                                                                                                                                                                      3
religion, sex, veteran status or political affiliation in its education or employment programs and activities, as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Educational Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
                                                                                                                            2011 Application for Admission


Section V. Commitment

Note to students: Please READ the following statements carefully and rewrite them in your own handwriting in
the lines that follow.

We at the Academy for International Studies agree to:
       Treat others as we would like to be treated
       Adhere to academic honesty and ethics
       Take responsibility for our own words and actions
       Respect each others’ uniqueness, diversity, feelings and property
       Contribute meaningfully to class every day
       Make an effort to learn more about the world around us every day
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

During the four years at HAIS, the graduating class of 2014 will experience:
           HCC College courses for both HCC and HISD credit on the HCC campus
           Possible internships with international businesses or organizations that meet the student’s career
            interests
           Second language proficiency with a focus on oral communication
           Local, national and international travel supported by student fundraising efforts
           Advanced Placement and dual credit courses that will challenge all students
           Community service projects


Commitment
We understand acceptance into the Houston Academy for International Studies involves a commitment
of service to the school, adherence to the Code of Ethics, participation in all HAIS required classes,
internships, community service projects, HCC college classes, intercultural exchange and travel locally,
nationally and internationally. It requires acceptance of parent participation in the school community in
family nights, conferences, and service to the school, helping in the classroom, chaperoning and
participating in community service projects and in the home through providing a time, place and
atmosphere to study and encouragement as necessary.                  It also requires providing for
transportation of your student to and from school in a timely manner every day.

Note to parents and students: Your signature indicates that you accept and embrace these attitudes and experiences and
make a commitment to your/your child’s education and enhancing the school community.

___________________________________                                                  ___________________________________________
Signature of Student                                                    Date                     Signature of Parent/Guardian                                            Date




It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national origin, marital status, race
                                                                                                                                                                                      4
religion, sex, veteran status or political affiliation in its education or employment programs and activities, as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Educational Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
                                                                                                                            2011 Application for Admission

Section VI. Personal Informational Interview

A student and parent informational interview is required as part of the application process. The purpose of
this informational interview is to make clear the expectations of HAIS and answer any questions that you
may have. An on-site writing sample and math evaluation will be completed on the day of the interview.

    I have an appointment for an informational interview on _________________________________

    I plan to call the school at 713-942-1430 to schedule an informational interview.


Return Complete Application with all required items to:

                                                     THE HOUSTON ACADEMY FOR INTERNATIONAL STUDIES
                                                                     1810 STUART
                                                                  HOUSTON, TX 77004
                                                                                          OR
                                                     THE HOUSTON ACADEMY FOR INTERNATIONAL STUDIES
                                                                      C/O B. LEOS
                                                                  HISD MAIL: ROUTE 10
                                                                                          OR
                                                                             FAX: 713-942-1433

      Please review the checklist carefully and ensure each item is complete:

      □ All sections of the application are complete

      □ Copy of Proof of Residence in HISD is attached (Utility Bill)

      □ Copy of Permanent Record Card

      □ Copy of most recent Report Card AND last two years report card

      □ Copy of most recent Stanford/Aprenda Scores

      □ Copy of most recent TAKS scores

      □ Copy of up-to-date Health Records including Immunization Card

      □ If applicable: The most recent ESL LPAC, Individual Education Plan (IEP) or 504 information
            Please note that if your child receives any of these services, a placement committee must meet to determine if HAIS is the appropriate
            educational setting for your child before your child can be accepted.


      □ I have requested the Teacher Survey Form from the following school based personnel:
        ___________________________________________________________________________

      □ I have scheduled an Informational Interview on the following date:_______________________

      □ Commitment form signed by BOTH parent/guardian and student




It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national origin, marital status, race
                                                                                                                                                                                      5
religion, sex, veteran status or political affiliation in its education or employment programs and activities, as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Educational Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.
                                                                                                                                    2011 Application for Admission




                                          The Houston Academy for International Studies High School
                                                           An Early College High School
                                        1810 Stuart • Houston, TX 77004 • 713-942-1430 • Fax: 713-942-1433
                                                                www.houstonais.org

To the Applicant: Complete this section only and give this form along with a stamped envelope (addressed to the
Academy or to B. Leos / Rt. 10) to a teacher of an academic class you have taken recently.
Student’s Name:
                                    Last                                                         First                                            Middle Initial
Current School
Address:
                                                                                     City:                                 State:                                Zip:

To the Teacher: Return this Survey Form in a signed and sealed envelope to the student or send directly to the Houston
Academy for International Studies via US mail or Rt. 10. This information will be utilized for planning purposes only. NO
student will be excluded from admissions solely based on the information that you share.

      1. How long have you known the applicant? In what context?



      2. What adjectives first come to mind when you think of the applicant?



      3. As advocate for this student, are there special circumstances that the school faculty should be aware of?


      4. In comparison to other students in his/her grade, please rate the applicant on the following criteria:
                                                                                                                                      Very Good

                                                                                                                                                     Excellent
                                                                                                       No Basis




                                                                                                                          Average
                                                                                                                   Poor




                                                               Criterion


                                          Motivation
                                          Academic Ability
                                          Artistic Ability
                                          Technical Ability
                                          Written Expression of Ideas
                                          Disciplined Work Habits
                                          Level of Maturity
                                          Positive Peer Interaction
                                          Intellectual Curiosity
                                          Energy

      5. Additional comments may be written here or on an additional sheet of paper.

Printed Name:                       _____________________________                                                 Position:                                      ______________
Signature:                          ____________________________                                                  School Name:                                   ______________
                                                                                     Date

It is the policy of the Houston Independent School District not to discriminate on the basis of age, color, handicap or disability, ancestry, national origin, marital status, race
                                                                                                                                                                                      6
religion, sex, veteran status or political affiliation in its education or employment programs and activities, as required by Title VI of the Civil Rights Act of 1964, as amended;
Title IX of the Educational Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended.

								
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