SENIOR OPTIONS Program Application
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1 Monroe Township High School SENIOR OPTIONS Program Application ALL FORMS MUST BE COMPLETED, SIGNED AND RETURNED NO LATER THAN WEDNESDAY, FEBRUARY 6, 2015 NAME: Available Options You may check more than one if you re not sure choose in order of preference (1, 2, 3, etc.) Community Service College Credit Internship Area? o Are you willing to do an unpaid internship? Work Study School Based Intern Area? Lab Service Teaching Mentorship CURRENT BLOCK 1A TEACHER: ROOM: CURRENT BLOCK 1B TEACHER: ROOM:
2 PERSONAL DATA NAME NICKNAME DATE OF BIRTH CELL PHONE PERSONAL FACEBOOK EDUCATION GOALS CAREER GOALS PARENT / GUARDIAN INFORMATION Parent/Guardian 1 Name Home Phone Cell Phone Preferred Means of Communication Parent/Guardian 2 Name Home Phone Cell Phone Preferred Means of Communication WORK EXPERIENCE - ATTACH ADDITIONAL PAGE, IF NEEDED EMPLOYER SUPERVISOR COMPANY NAME PHONE NUMBER NATURE OF WORK DATES OF EMPLOYMENT During your junior year, how many days were you absent? were you late for school? had ISS? had OSS? had an ASD?
3 PERSONAL BIOGRAPHY STUDENTS CHOOSE TO APPLY FOR THE SENIOR OPTION PROGRAM FOR A VARIETY OF REASONS. BECAUSE I DON T GET TO SPEND AS MUCH TIME AS I WOULD LIKE SPEAKING WITH EACH STUDENT, PLEASE WRITE AN BIOGRAPHY (TYPED PREFERRED), THAT WILL HELP ME TO KNOW YOU BETTER AS A PERSON AND AS A STUDENT. USE THIS TIME TO TELL ME WHAT YOU WHICH OPTION YOU WOULD LIKE TO PURSUE, WHAT YOU HOPE TO ACCOMPLISH IN TERMS OF YOUR EDUCATIONAL OR CAREER GOALS, AND HOW THE SENIOR OPTION PROGRAM WILL HELP YOU ACHIEVE YOUR OBJECTIVE. TELL ME WHAT YOU WOULD TELL SOMEONE WHO ASKED YOU THE QUESTION, TELL ME ABOUT YOURSELF. ATTACH YOUR STORY ON A SEPARATE SHEET(S) OF PAPER. PLEASE BE SURE TO PUT YOUR NAME ON ALL PAGES. AGREEMENTS, PERMISSION, RECOMMENDATIONS AND RELEASES THE FOLLOWING DOCUMENTS, PROPERLY SIGNED AND DATED, MUST BE RETURNED WITH YOUR APPLICATION: EARLY DISMISSAL AGREEMENT CODE OF CONDUCT MTHS TEACHER RECOMMENDATIONS SUBMISSION INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. BRING ALL ORIGINAL FORMS TO THE SENIOR OPTION OFFICE (IN THE MEDIA CENTER) NO LATER THAN FEBRUARY 7, IF YOU HAVE ANY QUESTIONS WHILE COMPLETING THE FORMS, VISIT MS. STASI IN THE SENIOR OPTION OFFICE, LOCATED IN THE MEDIA CENTER FOR FURTHER ASSISTANCE.
4 MONROE TOWNSHIP HIGH SCHOOL EARLY DISMISSAL AGREEMENT Senior Option Program Name: Date: We respectfully request permission for to be dismissed from school at the end of Block 3, Day A and/or B, if approved by a Structured Learning Experience Coordinator. * If granted, we understand that the student will be issued an early dismissal identification card which must be in their possession at all times during the school day. Furthermore, we assure the school administration that, if granted, he/she will have transportation away from school, and fully understand if found loitering on school property during the time of my early release, he/she will be referred to the designated Vice Principal for disciplinary action. We also understand that if our child is involved in any sport or after school activity while on early dismissal, he/she cannot re-enter the school building prior to 2:00 p.m. unless given specific, written permission from their coach or activity advisor. Any student failing to comply with this rule will be referred to the designated Vice Principal for disciplinary action. Finally, we understand that early dismissal is contingent upon the student s compliance with all other rules, regulations and/or obligations established by participation in the Senior Option Program. Failure to comply will result in rescission of both early dismissal and any parking privileges that may have been provided. If rescinded, student will be required to report to a specified location during 4 th block where student will be required to complete lessons and/or activities, as assigned. Student Signature: Date: Please print Parent/Guardian name Signature of Parent/Guardian * Students who do not require early dismissal to assure arrival at Middlesex County Community College or a specific location for internship, community service learning or work obligations are encouraged to enroll in 4 th block classes for the entire school year.
5 MONROE TOWNSHIP HIGH SCHOOL SENIOR OPTION PROGRAM Code of Conduct The Senior Option Program is an elective program designed to enable students to pursue a variety of personalized learning opportunities outside of the traditional classroom. The following Code of Conduct has been established to ensure that all participants are familiar with our expectations and how certain behaviors may have consequences beyond established school rules. 1. All participants will be regular in attendance, punctual in school and in fulfilling their Senior Option obligations 2. If a student is absent or suspended from school, in or out, the student is also suspended from Senior Option activities. Students assigned in-school suspension will be required to report to a SLE Coordinator during 4 th block. 3. Participants will contact their assigned SLE Coordinator before 7:00 AM, using or telephone, when it is necessary to be absent or late to school. 4. Participants will notify their supervising party before 9:45 AM that they will be absent from or late reporting to their Senior Option destination. 5. Participants understand that to be absent from school means that you are not permitted to engage in their Senior Option activities. 6. Participants understand that once their Senior Option is accepted and approved, it is under the direction and control of the SLE Coordinator. Therefore, any changes in schedule, duties, pay or other circumstances must be reported to your Coordinator. 7. Participants understand that no student may change or terminate employment without prior discussion with his/her SLE Coordinator. 8. Participants will conduct themselves, at school and in the community, in a manner that reflects favorably and honorably upon themselves, their families, their school, and the program they represent. 9. Participants will observe the rules of safety at all locations, regardless of how they may be observed by others and to report any personal accidents to your Supervisor and SLE Coordinator. (OSHA) 10. Participants will consult with a SLE Coordinator about any difficulties encountered as soon as they are aware that a problem exists.
6 11. Participants understand that their progress will be evaluated on a regular basis and that the evaluation results will be reflected in the grade for the Senior Option program. 12. Participants understand that the Senior Option class is curricular and students required to take the class must receive passing grades for both the class, and their structured learning experience (SLE) in order to receive full credit for the program. If student fails the class, he/she will not receive any credit for the class or the SLE. If student passes the class, but does not fulfill his/her hours requirement, student will receive 5 credits for class, but none for the SLE. 13. Participants will demonstrate cooperation, honesty, punctuality, courtesy, proper health and grooming habits, appropriate dress and a willingness to learn both in and out of school. 14. Participants must furnish the Coordinator with all necessary information, complete all reports and keep a daily record of time and training activities. Participants understand that they will receive credit only if assignments, journals, time sheets, and evaluations are satisfactorily completed and submitted on the dates stipulated by the SLE Coordinators. 15. Participants understand that some organizations may require drug testing. We understand that failure to comply with any part of this Code of Conduct may result in dismissal from the Senior Option Program. Student Signature Date Parent Signature Date
7 Senior Option Program Teacher Recommendation Form Student Name Completed by: Subject Please rate the student on each of the following areas of personal competence: (Please check the appropriate box) Grasps fundamental ideas and concepts: Integrates complex information: Completes assignments, fulfills contracts: Accepts constructive criticism: Assumes responsibility: Is motivated to achieve: Has good work habits; is disciplined Has positive sense of self: Shows potential for independent study: Has foundation in basic skills: Overall Rating: [ ] Highly recommend [ ] Recommend [ ] Recommend with reservation [ ] Do not recommend Teacher's Statement Special consideration should be given to this student because: Signature Date TEACHER - PLEASE RETURN TO STUDENT TO INCLUDE IN APPLICATION PACKET OR DIRECTLY TO SLE COORDINATOR.
8 Senior Option Program Teacher Recommendation Form Student Name Completed by: Subject Please rate the student on each of the following areas of personal competence: (Please check the appropriate box) Grasps fundamental ideas and concepts: Integrates complex information: Completes assignments, fulfills contracts: Accepts constructive criticism: Assumes responsibility: Is motivated to achieve: Has good work habits; is disciplined Has positive sense of self: Shows potential for independent study: Has foundation in basic skills: Overall Rating: [ ] Highly recommend [ ] Recommend [ ] Recommend with reservation [ ] Do not recommend Teacher's Statement Special consideration should be given to this student because: Signature Date TEACHER - PLEASE RETURN TO STUDENT TO INCLUDE IN APPLICATION PACKET OR DIRECTLY TO SLE COORDINATOR
LAKEWOOD SCHOOL DISTRICT CO-CURRICULAR ACTIVITIES CODE LAKEWOOD HIGH SCHOOL OPERATIONAL PROCEDURES FOR POLICY #4247
Page 2 of 14 LAKEWOOD SCHOOL DISTRICT CO-CURRICULAR ACTIVITIES CODE PHILOSOPHY It is the desire of the Lakewood School District that each student reach his or her academic potential. The Lakewood School
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