Youth in College Youth Teaching Academy Application June 15-19; 22-26, 2015 9:00 AM to 12:00 PM Bannach Elementary Registration Deadline: May 1, 2015 Youth Teaching Academy: UW-Stevens Point will be continuing the Youth Teaching Academy for the 2015 session of Youth in College. This program is for students from 12-18 years of age who would like to develop beginning teaching skills under the direction of an experienced teacher. Youth Teaching Academy Participant Expectations 1. Conduct yourself as a positive role model for Youth in College student participants. 2. Bring an upbeat, enthusiastic attitude into the classroom each day. 3. Teach skills to younger children under the direction of a Youth in College teacher. 4. Complete other tasks to assist a Youth in College teacher. 5. Wear your Youth Teaching Academy T-Shirt each day so that younger children can identify you if they should need help. Youth Teaching Academy Application Directions 1. Fill out the Youth in College Youth Teaching Academy Application. 2. Fill out the Youth in College Emergency Information Form. 3. Fill out the Youth in College Youth Teaching Academy Parental Releases and Hold Harmless Agreement. 4. Obtain a Letter of Recommendation Form from a current teacher. [Former Youth Teaching Academy participants are NOT required to submit a new Letter of Recommendation Form.] 5. Return the application form, the emergency form, and the letter of recommendation to the Youth in College office with a check for $12.00. This check should be made out to the Stevens Point Area School District. The participation fee is $12.00 for both In-District and Out-of-District students. 6. You will receive a letter confirming whether or not you were accepted by the end of May. Naomi Peuse UWSP Youth in College CPS, Room 433 1901 Fourth Avenue Stevens Point, WI 54481
Youth Teaching Academy Application Student Information Student s Preferred Name for Classroom Use (if different): Student s Grade (2014-2015 school year) (circle one): 6 th 7 th 8 th 9 th 10 th 11 th 12 th Home Address: City: Zip Code: Gender (circle one): Male Female Student Date of Birth (including year): Student s E-mail address: Preferred Telephone Number: ( ) T-Shirt Size (circle one): Small Medium Large X-Large XX-Large Parent/Guardian Name(s): Parent/Guardian E-mail Address: 1. Please list the classes and years you have attended Youth in College or other relevant experience you might have. 2. Write a paragraph explaining why you would be a good choice as a member of the Youth Teaching Academy. 3. Please list your preferences of Youth in College classes to which you would like to be assigned. Your choices will be taken into consideration, but you will be placed where you are needed. 1 st : 2 nd : 3 rd : If you have questions about the Youth Teaching Academy, please contact Dr. Gould at (715) 346-3223 or cgould@uwsp.edu.
Youth in College Youth Teaching Academy Emergency Information Form Parents /Guardians Names: Home Address: City, Zip Code: Parent/Guardian E-mail Address(es): Home Telephone Number: ( ) Cellphone Number: ( ) Additional Daytime Number: ( ) Health Information List any condition your child has of which the Network for Gifted Education staff should be aware (allergies, special needs, etc): Please list any medications your child is taking or may need to take while attending classes: Student s physician: Telephone: Student s dentist: Telephone: Please list two other people who may be contacted in an emergency if a parent/guardian cannot be reached: Name Relationship Telephone The Youth in College staff does not have any specialized medical training. We are able to handle cuts, scrapes, etc., but not significant medical conditions. If you have a child with a significant medical condition, please plan on staying in the building. If emergency treatment is required and a parent cannot be reached, may the Youth in College staff use their own judgment in contacting the physician indicated above, or, if not available an alternative physician or emergency care (circle one)? Yes No If you answer no, please indicate what you would like the Youth in College staff to do in a medical emergency: Registration is not valid without signature: Parent/Guardian Signature: Date:
Youth in College Youth Teaching Academy Parental Releases and Hold Harmless Agreement Student s Name: Student s Birth Date (including year): Parental Releases: I hereby give my permission for my child s photograph(s) taken during Youth in College, to be used in the program newsletter to be sent home with each child. I hereby give my permission for my child to attend program field trips and to be transported by school district or university vehicle for any field trip associated with this program or in case of medical emergency. Signature of Student: Signature of Parent or Guardian: Date: University of Wisconsin-Stevens Point Hold Harmless Agreement I agree to hold harmless and indemnify the State of Wisconsin, the Board of Regents of the University of Wisconsin System, and the University of Wisconsin Stevens Point, their officers, agents, and employees from any and all liability, loss, damages, costs, or expenses which are sustained, incurred, or required arising out of the actions of my son/daughter/parent/guardian while participating in the Youth in College program. Signature of Student: Signature of Parent or Guardian: Date:
Youth Teaching Academy Letter of Recommendation Form The student presenting this request for a letter of recommendation would like to become a member of the Youth Teaching Academy at Youth in College which is a summer school program for high-ability learners co-sponsored by the Stevens Point Area School District and UW-Stevens Point. This recommendation form may be returned to the student for submission with the other portions of their application. The requirements for a Youth Teaching Academy member are as follows: 1. Conduct yourself as a role model for younger children during Youth in College. 2. Bring a positive, upbeat, enthusiastic attitude into the classroom each day. 3. Teach skills to younger children under the direction of a Youth in College teacher. 4. Complete other tasks to assist a Youth in College Teacher. 5. Wear the Youth Teaching Academy T-Shirt each day so that younger children can identify them if they should need help. 6. Obtain a Letter of Recommendation Form from a current teacher. Would this student be a good fit as a Youth Teaching Academy member? Any comments about this student s motivation and character would be appreciated. Teacher s Name: Teacher s Signature: Date If you have questions please contact Dr. Christine Gould at (715) 346-3223 or cgould@uwsp.edu.