APPLICATION FOR ADMISSION DUE FEBRUARY 9, 2018 AT 5:00 PM Student Information Legal Last Name Legal First Name Middle Name Preferred Name Mailing Address City Zip Code Gender: Female Date of Birth Current Age MNPS Student ID number Male Current School Grade Family s Primary Contact Phone Number Has this student ever skipped a grade? No Yes, grade(s) skipped: How did you first hear about the SSMV? List other school(s) this student has attended over the last two years (include approximate dates of attendance): Which MNPS high school will you attend? Parent/Guardian Information (If custody is shared, please indicate who has primary custody of the child) Primary Contact: First Name Last Name Family s Primary Email Address (will be used for admissions purposes) Mailing Address (if different from applicant s) City State Zip Code Home Phone Cell Phone Work Phone Relationship to applicant Secondary Contact: First Name Last Name Secondary Email Address (only list if two separate people need to be contacted about admissions) Mailing Address (if different from applicant s) City State Zip Code Home Phone Cell Phone Work Phone Relationship to applicant
APPLICATION & ADMISSIONS AGREEMENT The School for Science and Math at Vanderbilt is a four year program designed for highly capable and motivated high school students. The curriculum is rigorous and will require students to be dedicated learners, open to new ideas, diligent in their work habits, intellectually honest, and willing to work collaboratively and respectfully with fellow students and university scientists. If accepted to the School for Science and Math, I agree to adhere to the following enrollment requirements: Commit to attending the School for Science and Math for four years during my high school attendance. Attend each class/laboratory day and session as required, missing only for medical or emergency reasons. Maintain high achievement at both the School for Science and Math and my zoned school. Follow the academic and social guidelines established at the School for Science and Math and conduct myself in accordance with the spirit and regulations of the Vanderbilt community. Student s Signature Date I, the undersigned parent/guardian, agree that the information provided on this application form is accurate and complete. I hereby grant permission and consent for my child to submit an application to the School for Science and Math at Vanderbilt. If accepted to the School for Science and Math, I understand that my child will need support and understanding as the SSMV is an additional and very important commitment for those who attend. I, the undersigned parent/guardian, approve the release of my child s records to complete his/her application to the School for Science and Math at Vanderbilt. For admissions purposes we will request the following: o TNReady scores (or equivalent) o current grades in all courses o additional assessments, attendance, and educational records, as needed NOTE Although we ask for grades and test scores, we take into consideration multiple factors in the admissions process. I understand that all information and materials of any kind received by the Admissions Office from any source, or prepared by anyone at its request, shall be completely confidential and shall not be disclosed to anyone, including the candidate and family, except at the discretion of the Director. Parent/Guardian s Name (printed) Parent/Guardian s Signature Date
APPLICATION SHORT ANSWER QUESTIONS(ANSWERS MUST BE WRITTEN IN ENGLISH) Student s Name: You may answer on a separate sheet of paper. Number your answers and put your name on every page. 1. List any academic recognition you have received, including any for science or math activities, during middle school: 2. List up to five extracurricular activities or hobbies that you have been most active in during middle school: 3. If you have participated in any previous science oriented experiences, please provide us with a general description and timeframe of experience (please use full, complete sentences): 4. What are three words or phrases your best friend would use to describe you and why (please use full, complete sentences)?
APPLICATION QUESTIONS (ANSWERS MUST BE WRITTEN IN ENGLISH) Please answer the following on a separate sheet of paper. Each answer should be one page, typed, and double spaced. Please put your name on each page. Give consideration to grammar and spelling. Cite all sources (books, articles, internet sources, etc.) that you use to answer these questions, and use quotation marks when copying information from any source. Plagiarism of any kind will be taken very seriously and may result in the disqualification of an application. PLEASE PUT YOUR NAME ON EVERY PAGE OF YOUR ESSAY ANSWERS SUBMIT THREE ESSAYS TOTAL Required Why do you want to attend the SSMV? If you are accepted, what will you contribute and what do you anticipate gaining from the SSMV? Choose any two topics from this list and write a brief, 1 2 page, thoughtful essay on each one What is the most important STEM related problem that our society will face in the next 10 years? What are one or two solutions you would propose to the problem stated? Describe a problem you ve solved or a problem you d like to solve. It can be an intellectual challenge, a research query, an ethical dilemma anything that is of personal importance, no matter the scale. Explain its significance to you and what steps you took or could be taken to identify a solution. Does living in a technologically advanced society have a positive or negative effect on your local community? Does it have a positive or negative effect on humanity? Explain.
CURRENT SCIENCE TEACHER EVALUATION AND RECOMMENDATION FORM (PAGE 1 OF 2) TEACHER: PLEASE RETURN THIS FORM TO THE ADDRESS BELOW NO LATER THAN FEBRUARY 9, 2018 AT 5:00 PM IF YOU WOULD LIKE TO COMPLETE THIS FORM ONLINE, EMAIL AMANDA.DIXON@VANDERBILT.EDU Student s Last Name First Name Middle School Current Science Course Title STUDENT: STOP HERE AND GIVE THIS FORM TO YOUR SCIENCE TEACHER The above named student is submitting an application to the School for Science and Math at Vanderbilt. We view the teacher recommendation as critical. All responses will be kept strictly confidential and are accessible by School for Science and Math admissions personnel only. We greatly appreciate your time and input. 1. Academic Qualities (Please check the box that best describes the student compared with others you have taught over your entire teaching career.) Class participation Study Habits/Ability to organize Thoroughness/Timeliness of assignments Willingness to seek help when needed Intellectual curiosity Creativity and originality of thought Ability to express ideas verbally Ability to express ideas in writing Self discipline/personal responsibility Maturity Good Superior Top 1% of students I have ever taught
CURRENT SCIENCE TEACHER EVALUATION AND RECOMMENDATION FORM (PAGE 2 OF 2) Please use a separate page. 2. Please tell us how long you have known this student, and in what capacity. Tell us about him or her as a person, including intellectual and academic abilities, but also taking into account character, emotional stability, and social development. 3. How has this student demonstrated an interest in science and/or math? 4. What is your overall recommendation for this student? Good Superior top 1% I have taught in my career 5. (Optional) If you are recommending more than one student to the SSMV, please provide a ranking for this student. This is very helpful for the admissions committee in determining the caliber of applicants from the same school. This student s rank Number of students I am recommending Teacher Name (printed) Teacher Signature Date Please send completed form to: School for Science and Math at Vanderbilt Attn: Amanda Dixon PMB 0365 230 Appleton Place Nashville, TN 37203 5721
CURRENT MATH TEACHER EVALUATION AND RECOMMENDATION FORM (PAGE 1 OF 2) TEACHER: PLEASE RETURN THIS FORM TO THE ADDRESS BELOW NO LATER THAN FEBRUARY 9, 2018 AT 5:00 PM IF YOU WOULD LIKE TO COMPLETE THIS FORM ONLINE, EMAIL AMANDA.DIXON@VANDERBILT.EDU Student s Last Name First Name Middle School Current Math Course Title STUDENT: STOP HERE AND GIVE THIS FORM TO YOUR MATH TEACHER The above named student is submitting an application to the School for Science and Math at Vanderbilt. We view the teacher recommendation as critical. All responses will be kept strictly confidential and are accessible by School for Science and Math admissions personnel only. We greatly appreciate your time and input. 1. Academic Qualities (Please check the box that best describes the student compared with others you have taught over your entire teaching career.) Class participation Study Habits/Ability to organize Thoroughness/Timeliness of assignments Willingness to seek help when needed Intellectual curiosity Creativity and originality of thought Ability to express ideas verbally Ability to express ideas in writing Self discipline/personal responsibility Maturity Good Superior Top 1% of students I have ever taught
CURRENT MATH TEACHER EVALUATION AND RECOMMENDATION FORM (PAGE 2 OF 2) Please use a separate page. 2. Please tell us how long you have known this student, and in what capacity. Tell us about him or her as a person, including intellectual and academic abilities, but also taking into account character, emotional stability, and social development. 3. How has this student demonstrated an interest in math and/or science? 4. What is your overall recommendation for this student? Good Superior top 1% I have taught in my career 5. (Optional) If you are recommending more than one student to the SSMV, please provide a ranking for this student. This is very helpful for the admissions committee in determining the caliber of applicants from the same school. This student s rank Number of students I am recommending Teacher Name (printed) Teacher Signature Date Please send completed form to: School for Science and Math at Vanderbilt Attn: Amanda Dixon PMB 0365 230 Appleton Place Nashville, TN 37203 5721
OPTIONAL SCIENCE OR MATH EVALUATION AND RECOMMENDATION FORM (PAGE 1 OF 2) READ CAREFULLY, ONLY RECOMMENDATIONS THAT MEET THE CRITERIA WILL BE READ MUST BE COMPLETED BY A MATH OR SCIENCE TEACHER MAY BE COMPLETED BY A DAY OF DISCOVERY OR ENCORE INSTRUCTOR WHO CAN COMMENT ON YOUR INTEREST AND PERFORMANCE IN MATH AND SCIENCE OR MAY BE COMPLETED IN EXTENUATING CIRCUMSTANCES SUCH AS IF YOUR REGULAR MATH OR SCIENCE TEACHER HAS NOT BEEN YOUR TEACHER FOR THE FULL FALL SEMESTER OR IS A VIRTUAL SCHOOL TEACHER. TEACHER: PLEASE RETURN THIS FORM TO THE ADDRESS BELOW NO LATER THAN FEBRUARY 9, 2018 AT 5:00 PM IF YOU WOULD LIKE TO COMPLETE THIS FORM ONLINE, EMAIL AMANDA.DIXON@VANDERBILT.EDU Student s Last Name First Name Middle School Course Title and Grade Level STUDENT: STOP HERE AND GIVE THIS FORM TO YOUR TEACHER The above named student is submitting an application to the School for Science and Math at Vanderbilt. We view the teacher recommendation as critical. All responses will be kept strictly confidential and are accessible by School for Science and Math admissions personnel only. We greatly appreciate your time and input. 1. Academic Qualities (Please check the box that best describes the student compared with others you have taught over your entire teaching career.) Class participation Study Habits/Ability to organize Thoroughness/Timeliness of assignments Willingness to seek help when needed Intellectual curiosity Creativity and originality of thought Ability to express ideas verbally Ability to express ideas in writing Self discipline/personal responsibility Maturity Good Superior Top 1% of students I have ever taught
(OPTIONAL SCIENCE OR MATH EVALUATION AND RECOMMENDATION FORM (PAGE 2 OF 2) READ CAREFULLY, ONLY RECOMMENDATIONS THAT MEET THE CRITERIA WILL BE READ Please use a separate page. 2. Please tell us how long you have known this student, and in what capacity. Tell us about him or her as a person, including intellectual and academic abilities, but also taking into account character, emotional stability, and social development. 3. How has this student demonstrated an interest in math and/or science? 4. What is your overall recommendation for this student? Good Superior top 1% I have taught in my career 5. (Optional) If you are recommending more than one student to the SSMV, please provide a ranking for this student. This is very helpful for the admissions committee in determining the caliber of applicants from the same school. This student s rank Number of students I am recommending Teacher Name (printed) Teacher Signature Date Please send completed form to: School for Science and Math at Vanderbilt Attn: Amanda Dixon PMB 0365 230 Appleton Place Nashville, TN 37203 5721
APPLICATION CHECKLIST (YOUR APPLICATION IS NOT COMPLETE WITHOUT ALL OF THE FOLLOWING DOCUMENTS) Application for Admission Student s Name: Application & Admissions Agreement Short Answer Questions Three Essay Questions (with your name on every page) Science Teacher Recommendation 2 pages (teacher name: ) Math Teacher Recommendation 2 pages (teacher name: ) Optional Additional Teacher Recommendation 2 pages (teacher name: ) Your application is not complete until all of the listed materials have been received in the School for Science and Math office. Applications without all parts completed and turned in on time will not be considered. We must have original copies of all application documents. Please make a copy to keep for your records. The deadline for all application documents to reach the School for Science and Math office is 5:00 P.M. on February 9, 2018. Hand delivered applications and recommendations are strongly discouraged and may not be accepted. We recommend planning ahead and requesting a delivery confirmation from the post office. Students who are not selected for admission to the SSMV may have this application sent directly to the Interdisciplinary Science and Research (ISR) Program at Hillsboro, Stratford, or Overton high schools if you are in the cluster. Yes, forward my application to ISR at (circle one) Stratford/Hillsboro/Overton if I am not selected for admission to the SSMV. Mailing Address: School for Science and Math at Vanderbilt Attn: Amanda Dixon PMB 0365 230 Appleton Place Nashville, TN 37203 5721 Phone: (615) 322 7132