ABSS Early College @ ACC Name: Student/Parent Application Due to Middle School Guidance Counselor or Early College by Tuesday, 01/29/19 Student Application Please Print: First Middle Last Home Phone: Email: Birth date: Name of school you attend: Grade Level: Current Math Course: 8 th Grade Math Math 1 Math 2 2 nd 9 Weeks Grade: Current Language Arts Course: 8 th Grade Language Arts Other 2 nd Nine Weeks Grade: Name of any sibling who has or is currently attending Early College or attended Middle College: If you are applying from a school that is NOT an ABSS school, please complete the following questions. Failure to respond accurately will result in invalidating the application: Have you ever attended an ABSS school? If yes, what school(s)? Have you ever attended a public school other than ABSS? If yes, what school, where? Please complete the following: (Use the back if you need more room. Or, you may write or type your answers on a separate sheet to attach.) 1. Activities and Interests List the activities in which you have been involved in the last two years. Please also include leadership roles that you have in those activities: School Activities: Community Activities: Volunteer/Service Activities: In compliance with federal laws, the Alamance Burlington School System administers all educational programs, employment activities and admissions without discrimination because of race, religion, national or ethnic origin, color, age, military service, disability, or gender, except where exemption is appropriate and allowed by law. Inquiries or complaints should be directed to: Emmet Alexander, Assistant Superintendent, School Administration, Alamance Burlington School System, 1712 Vaughn Road, Burlington, NC 27217, (336 570 6060).
2. About you Think about your favorite class or subject at school this year and your least favorite class at school this year. Below, name the classes and describe yourself as a learner in both classes. Favorite class: Least favorite class: 3. Goals and Plans What goals do you plan to achieve as a high school student at the ABSS Early College @ ACC? What plans have you considered, or what dreams do you have for your life after high school? 4. Interest in ABSS Early College @ ACC Explain why you are interested in attending the ABSS Early College @ ACC. What special talents and/or skills can you contribute to the Early College? 2
Two teacher recommendations are required with the application. One should be a current core teacher. The other may be any teacher you have had during your middle school years. Teacher recommendation forms are the last two pages of the application. All students who submit a complete application form and qualify for the program will participate in a group interview and complete a short written essay. 5. Other Information Is there other information that you would like for us to know about you? 3
Parent Application: Name of Parent/Guardian completing this form: Relationship to Student: Residence (With whom does the student live?): Mother Father Father and Mother Guardian/Other (explain) Mother and Stepfather Father and Stepmother Grandparent(s) Mailing/Contact (for student): Address: City/State/Zip: Home Phone: Cell Phone: Email: Parent/Guardian Information: Parent/Guardian #1 Name: Address: City/State/Zip: (Complete only if different from the address above.) Last Grade Completed: (Check one) 1 2 3 4 5 6 7 8 9 10 11 12 Did you attend college? If yes, what college: Years Completed: (check one) 1 2 3 4 4+ Year graduated: Current Employer: Position: Work Phone Number: Email: Other family members attending or who have attended college: 4
Parent/Guardian #2 Name: Address: City/State/Zip: (Complete only if different from the address above.) Last Grade Completed: (Check one) 1 2 3 4 5 6 7 8 9 10 11 12 Did you attend college? If yes, what college: Years Completed: (check one) 1 2 3 4 4+ Year graduated: Current Employer: Position: Work Phone Number: Email: Other family members attending or who have attended college: Applicant Signature and Agreement By signing the application, I am acknowledging I wish to be accepted into the Alamance Burlington Early College at ACC. I certify the information provided above is complete and accurate. I further agree to observe all rules and regulations of Alamance Burlington Early College at ACC and Alamance Burlington School System if selected to attend. Signature of Applicant Date Parent/Guardian Signature and Agreement We agree the applicant will remain at ABSS Early College @ACC for the entire 2019 20 school year if selected. Signature of Parent/Guardian (if applicant is under 18 years of age) Date All Early College students must be Alamance County residents. If your student is not currently attending an ABSS school, please submit with this application two current proofs of residence using any of the following documents: utility bill, current property tax statement, municipal gas bill, municipal water bill, rental/lease agreement that shall include the name of the legal custodian of the said child, copy of deed to home that shall include the name of the legal custodian of the said child. 5
Early College Teacher Recommendation Form (One current social studies, math, English OR science teacher and one teacher from 6 8 grade of any subject.) Please place a check beside any of the criteria that you know this applicant meets. Current 8 th Grader Alamance County Resident Demonstration of academic promise No pattern of disciplinary problems Desire to succeed Please indicate your overall support: I highly recommend this student. I recommend this student. I recommend this student with some reservations. I do not recommend this student. I do not know the student well enough to provide a recommendation. Special Circumstances: Does the student have any special or unique circumstances that we should be aware of in the selection process? Please feel free to attach additional comments. 6
Early College Teacher Recommendation Form (One current social studies, math, English OR science teacher and one teacher from 6 8 grade of any subject.) Please place a check beside any of the criteria that you know this applicant meets. Current 8 th Grader Alamance County Resident Demonstration of academic promise No pattern of disciplinary problems Desire to succeed Please indicate your overall support: I highly recommend this student. I recommend this student. I recommend this student with some reservations. I do not recommend this student. I do not know the student well enough to provide a recommendation. Special Circumstances: Does the student have any special or unique circumstances that we should be aware of in the selection process? Please feel free to attach additional comments. 7