THANK YOU FOR APPLYING TO PROVIDENCE HIGH SCHOOL! This check list is to assist you in completing the application process: Download all 7 pages of the PHS application. You will need to print out the packet and PRINT in pen all necessary information. Complete the Focus Program page only if you are applying to the Medical, Cinema Arts or Technology Focus Program. You will need to download and print 2 copies of the Evaluation Form. Include your Birth Certificate and Baptismal Certificate. Include your $75 application fee. You may drop off the completed application packet to the Main Office of the school. Due date is January 14, 2016 Parents! Please make sure that you download both parts of the application to include the Evaluation Forms. Sign the Release of Records Form and Evaluation Forms and submit these to your CURRENT school. Your current school will mail the transcripts and evaluation forms directly to Providence High School. This information is due February 4, 2016. If you have any questions regarding this process please call the Admissions Team. We look forward to assisting you! Judy Egan Umeck Rose Piazza Greg Castro Director of Admissions Admissions Asst. Community Outreach Coordinator 818-846-8141 ext. 14501 ext. 14511 ext. 14510
Legal Name of Student 2016-2017 PROVIDENCE HIGH SCHOOL APPLICATION PHS TESTING IS ON SATURDAY, JANUARY 30, 2016 FROM 9:00 1:00 PM Applications are due January 14, 2016 Applying to grade Last Name First Name MI Preferred First Name of student Please circle gender MALE FEMALE Birth Place Birth date - - Social Security # - - mm dd yyyy Correspondence should be sent to: (Title for salutation purposes. Use Mr. & Mrs. if student lives with both parents.) Please Circle: Mr. & Mrs. / Mr. / Mrs. / Ms. / Dr. First Name Last Name Street Number Street Apt. # City State Zip code Home Phone Number ( ) - E-Mail Address Name of Father Name of Mother (Legal) First Last (Legal) First Last Employer (If self-employed give name of business) Employer (If self-employed give name of business) Position (Be specific, include title if applicable) Business Phone ( ) Position (Be specific, include title if applicable) Business Phone ( ) Cell Phone ( ) Cell Phone ( ) E-Mail E-Mail Signature Signature To assist us in communicating with your household please indicate the language spoken in your home. Primary language spoken by parents in the home Secondary language spoken in the home Current School Principal School Address Phone # Religion Church Attending OVER
STUDENT STATEMENT Please tell us about the activities you are involved in: community service, athletics, drama, music, academic honors, leadership positions etc. You may use an extra sheet of paper if needed. ACTIVITY GRADE PERFORMANCE /POSITION /AWARD Example: Student Council 6-8 Vice-President Example: Soup Kitchen 7 Helped at church Please indicate if you have ever attended an event at Providence High School. Sports Visual /Performing Arts Admission Event Other PARENT QUESTIONARE Parents are: Married Divorced Single Separated Widow/Widower Mother remarried Father remarried Student lives with: Both Parents Mother Father Other, specify Legal custody held by: Mother Father Joint Please provide court document discussing custody and education. List siblings: Name age School Name age School Name age School Name age School Is there any special circumstance, diagnosis or information you would like to share about your child? As a parent, what has attracted you to Providence High School? What expectations do you have for your child here? Please indicate name of parent or family member who has graduated from or is attending PHS. Name year Name year Please indicate with your initials that you have completed all sections. 1. Include a copy of the student s baptismal and birth certificates. 2. Include a check for the application fee, made payable to Providence High School. The fee is $75. 3. I have read and learned about the Focus Programs (Medical, Cinema Arts & Technology) & submitted project 4. I have read all information packet that I received with this application. 5. I understand that request for financial assistance is a separate application and must be submitted by February 4, 2016. I HAVE READ THE ENTIRE APPLICATION AND HAVE COMPLETED ALL SECTIONS. Student s Signature: Date
FOCUS PROGRAM APPLICATION CINEMA ARTS FOCUS PROGRAM The Cinema Arts Program is designed to enrich the overall college preparatory education that every Providence student receives. It is the presumption of the Department Director that the students involved in this program will assume leadership roles in the media industry at some future point in their lives. With this in mind, Cinema Arts students are held to the highest standards of artistic excellence and creative integrity. Upon completion of the four year cinema arts program, our students are uniquely qualified to compete for positions at the best film and media schools in the nation. Criteria for Entrance 1. Interest 2. Record of grades / test scores 3. Example of media related work 4. Approval of Administration & Program Director 5. Approval of Program Director Criteria for Continuance 1. Interest 2. Cumulative GPA of 2.5 3. Performance in class 4. Participation in program MEDICAL FOCUS PROGRAM The Medical Focus Program is an exploratory opportunity for students attracted to pursuing a career in the field of health care with a unique way for students to learn more about a fascinating and truly rewarding career. In keeping with the mission and vision of Providence Health and Services, the program embraces the core values of Compassion, Justice, Excellence, Commitment, and Stewardship. These values enable the individual to become a better health care provider serving the needs of the community. Criteria for Consideration 1. Interest, enthusiasm and motivation 2. Strong recommendations and transcripts 3. Competitive entrance exam score 4. Handwritten essay following the directions below 5. Approval of program director Criteria for Continuance 1. Continued interest, commitment and motivation 2. Cumulative GPA of 3.0 or better 3. Active participation in internships at medical 4. Continued approval of program director TECHNOLOGY FOCUS PROGRAM The Technology Focus Program is a four-year voyage into the world of all things technology. The basic structure of the program is: 1. Game Programming 3. AP Computer Science 2. Robotics 4. Technology Integration/Social Media and Marketing Within the four years, students are presented with many different facets of current technology, with the aim of presenting them with a variety of avenues for future study and employment. Additionally, students have the opportunity to participate in our award-winning Robotics Club, which last year featured a 5th place award in the National Robotics League National Championships. The Information Science Department at Providence High School takes the ever-present role of information science seriously. Our curriculum is designed to provide students with the maximum flexibility to integrate their mathematical, literary, historical, scientific and ethical studies to demonstrate that the computer, better yet said the information life cycle, is a prominent idea in all aspects of education. I am applying to one of the PHS Focus Programs. I understand it is a 4 year elective program in addition to the college preparatory curriculum. Juniors & Seniors are not eligible. Please initial: NO YES: Medical Focus Media Focus Technology Focus CINEMA ARTS FOCUS PROGRAM: Submit one of the following projects: a storyboard for a short film or animated piece, a script, newspaper, or magazine article you have written; write about an idea you may have to rock the entertainment industry! MEDICAL FOCUS PROGRAM: Keeping in mind there will be after school projects; What are your short term and long term goals? How does enrollment in the Medical Focus Program meet these goals? Describe your participation in any volunteer or Science program. TECHNOLOGY FOCUS PROGRAM: What programs are you familiar with? What do you hope to learn from this focus in addition to your college preparatory program?
PARENTS: PLEASE SIGN AND RETURN THIS SHEET TO YOUR STUDENT S CURRENT SCHOOL PROVIDENCE HIGH SCHOOL 511 South Buena Vista Street Burbank, CA 91505 (818) 846-8141 x 501 FAX (818) 843-8421 www.providencehigh.org RELEASE OF RECORDS To: Date: Elementary School Principal or Middle/High School Counselor The student named below is applying for high school admission. I authorize you to release all requested information to Providence High School. Student Name: Present Grade: Signature of Parent or Legal Guardian: The Administration of Providence High School appreciates your assistance in providing a complete academic transcript. A student will not be considered unless all required information is received. Please read the following information carefully. A complete transcript for grade 9 applicant consists of: records for grade 7 and the first semester of grade 8 (second semester is due upon promotion) and all standardized testing. Two PHS academic reference forms completed by the 8 th grade teacher and principal or English and Math teachers with principal or school counselor signature. A complete transcript for grade 10 applicant consists of: records for grade 7, 8 and the first semester of grade 9 (second semester is due upon promotion) high school placement test, if applicable, and all past standardized testing. Two PHS academic reference forms are to be completed by the current English and Math teacher and signed by the school principal or counselor. Provide a copy of your current school profile. This can be obtained through the school counseling office. A transfer student should achieve a C or better in their academic course work and demonstrate the ability to successfully participate in a college preparatory program at Providence High School. A complete transcript for a grade 11 applicant consists of: 9 th and 10 th grade transcripts with evidence of college classes, all standardized test scores including high school placement test. Two PHS academic reference forms are to be completed by the current English and Math teacher and signed by the school principal or counselor. Provide a copy of your current school profile. This can be obtained through the school counseling office. A transfer student should achieve a C or better in their academic course work and demonstrate the ability to successfully participate in a college preparatory program at Providence High School. If grades differ from the ABCDF format please provide interpretation. There are times that international grading practices require additional outside evaluation. Any cost for additional evaluation is the responsibility of the parent. All information received is regarded as confidential. INFORMATION IS DUE FEBRUARY 4, 2016 Thank you for sending these materials directly to: ADMISSIONS OFFICE Providence High School 511 South Buena Vista St. Burbank, Ca. 91505
ENGLISH CONFIDENTIAL EVALUATION FORM Paper work deadline is Feb. 4, 2016 THIS SECTION IS COMPLETED BY A PARENT OF THE STUDENT APPLICANT PARENTAL PERMISSION FOR RELEASE OF INFORMATION: I hereby give my permission for the elementary/middle school to send student information to the requested Catholic high schools. I waive my right to view these records. PARENT/LEGAL GUARDIAN SIGNATURE: PARENT/LEGAL GUARDIAN PRINTED NAME: DATE: NAME OF APPLICANT: LAST FIRST MIDDLE HOME ADDRESS: STREET CITY STATE ZIP EMAIL ADDRESS: HOME PHONE: ( ) - SCHOOL NOW ATTENDING: NAME OF SCHOOL CITY DATE ENTERED CURRENT SCHOOL (Month/Year) TO THE PRINCIPAL, ENGLISH TEACHER, AND MATH TEACHER: This form is to be completed by a school official and returned directly to each high school. This CONFIDENTIAL evaluation will be used only by persons on the Admissions Committee and will not become part of the student s cumulative folder. Therefore, this form will not be open to general review and will not be forwarded to any other school or institution. Your carefully considered judgment will have a strong and direct bearing on this student s acceptance. Please provide information which you think should influence our decision, i.e. gifts, talents, abilities in/outside of the classroom, and/or any challenges or difficulties the student might have faced. We appreciate your honesty and your effort. POSITION OF PERSON COMPLETING FORM: MATH & ENGLISH ARE REQUIRED PRINCIPAL (optional) ENGLISH/LANGUAGE ARTS TEACHER MATH TEACHER (Text Book) OTHER (specify) PRINTED NAME OF PERSON COMPLETING EVALUATION: EMAIL ADDRESS OF PERSON COMPLETING EVALUATION: SIGNATURE REQUIRED: DATE: SCHOOL: PHONE: SCHOOL ADDRESS STREET CITY ZIP CODE
NAME OF APPLICANT: LAST FIRST MIDDLE Confidential Common Evaluation Form STUDENT RATING EXCELLENT GOOD AVERAGE POOR UNABLE TO RESPOND MOTIVATION: SENSE OF RESPONSIBILITY: PERSONAL RELATIONSHIPS: INITIATIVE AND LEADERSHIP: COOPERATION/EFFORT GENERAL CONDUCT/BEHAVIOR WORK AND STUDY HABITS INTEGRITY DEMONSTRATION OF FAITH PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT MAY BE HELPFUL IN EVALUATING THIS STUDENT: ATIONS STRONGLY ACADEMICALLY WITH RESERVATIONS DO NOT (Please explain) SPECIAL CIRCUMSTANCE OBSERVED CHARACTER OVERALL PRINTED NAME OF PERSON COMPLETING EVALUATION: POSITION
MATH CONFIDENTIAL EVALUATION FORM Paper work deadline is Feb. 4, 2016 THIS SECTION IS COMPLETED BY A PARENT OF THE STUDENT APPLICANT PARENTAL PERMISSION FOR RELEASE OF INFORMATION: I hereby give my permission for the elementary/middle school to send student information to the requested Catholic high schools. I waive my right to view these records. PARENT/LEGAL GUARDIAN SIGNATURE: PARENT/LEGAL GUARDIAN PRINTED NAME: DATE: NAME OF APPLICANT: LAST FIRST MIDDLE HOME ADDRESS: STREET CITY STATE ZIP EMAIL ADDRESS: HOME PHONE: ( ) - SCHOOL NOW ATTENDING: NAME OF SCHOOL CITY DATE ENTERED CURRENT SCHOOL (Month/Year) TO THE PRINCIPAL, ENGLISH TEACHER, AND MATH TEACHER: This form is to be completed by a school official and returned directly to each high school. This CONFIDENTIAL evaluation will be used only by persons on the Admissions Committee and will not become part of the student s cumulative folder. Therefore, this form will not be open to general review and will not be forwarded to any other school or institution. Your carefully considered judgment will have a strong and direct bearing on this student s acceptance. Please provide information which you think should influence our decision, i.e. gifts, talents, abilities in/outside of the classroom, and/or any challenges or difficulties the student might have faced. We appreciate your honesty and your effort. POSITION OF PERSON COMPLETING FORM: MATH & ENGLISH ARE REQUIRED PRINCIPAL (optional) ENGLISH/LANGUAGE ARTS TEACHER MATH TEACHER (Text Book) OTHER (specify) PRINTED NAME OF PERSON COMPLETING EVALUATION: EMAIL ADDRESS OF PERSON COMPLETING EVALUATION: SIGNATURE REQUIRED: DATE: SCHOOL: PHONE: SCHOOL ADDRESS STREET CITY ZIP CODE
NAME OF APPLICANT: LAST FIRST MIDDLE Confidential Common Evaluation Form STUDENT RATING EXCELLENT GOOD AVERAGE POOR UNABLE TO RESPOND MOTIVATION: SENSE OF RESPONSIBILITY: PERSONAL RELATIONSHIPS: INITIATIVE AND LEADERSHIP: COOPERATION/EFFORT GENERAL CONDUCT/BEHAVIOR WORK AND STUDY HABITS INTEGRITY DEMONSTRATION OF FAITH PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT MAY BE HELPFUL IN EVALUATING THIS STUDENT: ATIONS STRONGLY ACADEMICALLY WITH RESERVATIONS DO NOT (Please explain) SPECIAL CIRCUMSTANCE OBSERVED CHARACTER OVERALL PRINTED NAME OF PERSON COMPLETING EVALUATION POSITION