APPLICATION FOR ADMISSION (Part A)

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APPLICATION FOR ADMISSION (Part A) Please type or print in black ink. All parts of this application must be received by February 2, 2018. Section I Name Male Female Permanent mailing address: Number and street City State Zip/Postal Code Country Home telephone: ( ) Parent Cell Phone: ( ) Email address (Parent): Date of Birth: Is English your native language: Yes No Place of Birth: Month date year city & state country Age: Section II Parents or Guardians: (Please indicate custodial parent, if applicable) Mother: Father: last first last first address (if different from above) address (if different from above) ( ) ( ) ( ) ( ) home phone work phone home phone work phone Section III High School you will attend: Section IV School in which you are currently enrolled: Current Counselor s name: *Submit two academic recommendations on the forms provided about your academic strengths, achievement, and character. Both should be from current teachers or other educators who currently work with you academically. Neither individual should be related to you. Each recommendation should be mailed directly to The Scholars Academy by the recommender. *Write an essay (250 to 500 words, double-spaced, and typewritten) on one of these topics: A. Describe a setback or ethical dilemma that you have faced. How did you resolve it? How did the outcome affect you? If something similar happened in the future, how would you react? B. Discuss an issue of local, national, or international concern. Why is this issue important to you? How do you think it should be addressed? Include a complete bibliography for any sources used. Your essay will be evaluated on content, organization, control of language, and voice (word choice & sentence structure). Submit your essay with your application.

APPLICATION FOR ADMISSION (Part B) This part of the application must be signed by the parent or guardian and the student. Please type or print in black ink. Student Name Complete the following questions by including as much detail as possible: A. Why are you interested in attending the Scholars Academy? B. What kinds of books, magazines, or other periodicals do you like to read? What is the last thing you have read (other than required reading)? Why did you read this selection and what did you learn? C. Do you plan to participate in athletics, a performing arts program, or other organized extra curricular activities at your base school? If so, which one(s)? D. As a Scholars Academy student, you will be moving away from your circle of friends. How will this impact you? How easily do you make new friends? E. The Scholars Academy offers an academically demanding curriculum, requiring of its students a greater level of maturity. In the past, how did you handle: 1.... too much work with too little time? 2.... the feeling or certainty that you were ahead of the rest of the class? 3.....conflicts with students and/or teachers? 4.... being required to take classes in which you have no interest?

F. Students at the Scholars Academy are encouraged to participate in extracurricular activities and/or public service projects. What kinds of activities/projects interest you? G. Describe any reservations you may have about attending the Scholars Academy. H. Have you taken or are you in the process of taking Algebra I? (Algebra I credit is necessary for participation.) I. Please list your extracurricular, community, and family activities, school clubs, hobbies, as well as community service projects, in the order of their interest to you. List only the activities and hobbies in which you have been involved during the last 12 months. Please those activities and hobbies you hope to continue at the Scholars Academy. Club, Activity, or Hobby J. What is your mode of transportation to the Scholars Academy? Do you have a back-up plan? School Bus Family Transportation/Car Pool Other (Explain) Students may have college classes on the Teacher In-service days (Grades 9-12) and Spring Break (Grades 10-12) throughout the year. Will you be able to provide your own transportation since buses do not run on those days? K. What other information would you like to share with us? If necessary, one additional page may be attached for this purpose.

PLEASE READ CAREFULLY Before Signing: By signing below, we acknowledge that all information is accurate and complete as stated within this application. Completing this application is not a guarantee of being interviewed for the program. An admissions committee will screen recent standardized test results, as well as attendance and discipline records, for each applicant. Applications will be ranked based on responses, recommendations, test scores, and other information provided. Two weeks of interviews with the highest ranking applicants will be held to fill the available seats. Program directors reserve the right to review the permanent record of each applicant and will have access to applicant s University of SC Upstate course grades while he/she is enrolled in the Scholars Academy. By submitting this application, we acknowledge our understanding of the effort and time the student is undertaking if accepted into the Scholars Academy. We understand that the program operates on a college campus; as such, students are expected to be responsible members of the community and to maintain As and Bs in all courses. We recognize that acceptance at the Scholars Academy requires a minimum one year commitment. Voluntary leave requests will be subject to the exit policy explained below. Students who exit the program voluntarily must reimburse the Academy for costs as outlined in the policy below. Finally, we have reviewed my school district s policy regarding Scholars Academy tuition, textbooks, transportation, and graduation recognitions. VOLUNTARY EXIT POLICY In keeping with the mission of the Scholars Academy to attract and graduate students, it is understood that students who accept the invitation to participate in the Academy will persist in its course of study to graduation. Students who do not maintain adequate academic standing will be placed on probation or will be dismissed per the relevant policy. Students who maintain good academic standing are expected to graduate from the program. Students who choose to exit the Scholars Academy after the start of any academic semester and initial meeting of college classes will be held financially liable to reimburse the expenses incurred in providing the student s seat in college courses for that semester. The cost is currently $198 per 3-hr course and $264 per 4-hr course; the total will be reimbursed to USC Upstate for credit to the Scholars Academy account. Any request for a waiver to this policy will be reviewed by the Scholars Academy Executive Board. Appeals may be initiated by contacting Melissa DeLoach, Director of The Scholars Academy, at 864-503-5506 at USC Upstate. Student Signature Date Parent/Guardian s PRINTED NAME Relationship (Mother / Father / Guardian / Other) Parent/Guardian s Signature Date Proofread everything, be sure appropriate signatures are on the forms, and return this application and all requested documents to your guidance counselor at your current school. Counselors will complete the process and send all application packets to: Melissa DeLoach, Director The Scholars Academy University of South Carolina Upstate 800 University Way Spartanburg, South Carolina 29303 All parts of the application must be received at the above address by February 2, 2018. Selected applicants will be scheduled for a personal interview during the month of March 2018. Discrimination of all persons is prohibited with regard to employment and any other program or activity on the basis of race, religion, sex, national origin, age, color, immigrant status, English speaking status or disabling condition in Spartanburg County Schools as required by Title IX of the Educational Amendments Act of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Civil Rights Act of 1964 as amended.

ACADEMIC RECOMMENDATION #1 To the applicant: Complete this section only and give this form to a current teacher. Student s Name Student s Current School To the recommender: The student named above is applying for admission to the Scholars Academy. Please use this form to share with us your perceptions of how this student will meet the academic and social responsibilities of the school. Please mail this completed form no later than February 2, 2018, to: Melissa DeLoach, The Scholars Academy, USC Upstate, 800 University Way, Spartanburg, SC 29303. How long have you known the applicant? In which grade/subject did you teach the applicant? What two words (or phrases) come to mind when you think of this applicant? Describe the applicant s academic performance and intellectual curiosity: In comparison to other students in the same grade, please rate the applicant on the following: Academic motivation Outstanding (top 5%) Excellent (next 10%) Above Below Intellectual ability Interaction with peers Emotional maturity Respect accorded by faculty Perseverance

Describe the applicant s level of involvement and success in class discussions and group projects. How well does the applicant work without direct supervision? Does the applicant have the capacity for independent work? How well does the applicant respond to personal setbacks and academic challenges? What makes the applicant a memorable student at your school? Recommender s Printed Name Position / Title School s Name Recommender s Signature Date

ACADEMIC RECOMMENDATION #2 To the applicant: Complete this section only and give this form to a current teacher. Student s Name Student s Current School To the recommender: The student named above is applying for admission to the Scholars Academy. Please use this form to share with us your perceptions of how this student will meet the academic and social responsibilities of the school. Please mail this completed form no later than February 2, 2018, to: Melissa DeLoach, The Scholars Academy, USC Upstate, 800 University Way, Spartanburg, SC 29303. How long have you known the applicant? In which grade/subject did you teach the applicant? What two words (or phrases) come to mind when you think of this applicant? Describe the applicant s academic performance and intellectual curiosity: In comparison to other students in the same grade, please rate the applicant on the following: Academic motivation Outstanding (top 5%) Excellent (next 10%) Above Below Intellectual ability Interaction with peers Emotional maturity Respect accorded by faculty Perseverance

Describe the applicant s level of involvement and success in class discussions and group projects. How well does the applicant work without direct supervision? Does the applicant have the capacity for independent work? How well does the applicant respond to personal setbacks and academic challenges? What makes the applicant a memorable student at your school? Recommender s Printed Name Position / Title School s Name Recommender s Signature Date

COUNSELOR S REPORT for acceptance in 2018-2019 School Year This part of the application must be completed by the 8 th grade guidance counselor. Please mail this completed form along with attachments no later than February 2, 2018 to: Melissa DeLoach, The Scholars Academy, USC Upstate, 800 University Way, Spartanburg, SC 29303. I. Applicant s name: II. Attach grade, attendance, and discipline reports. Middle School Record SUBJECTS (List all courses in which the student has earned or will earn a Carnegie unit for graduation by the end of 8 th grade.) GRADES (Current grade in each credit-earning course listed at left.) REMARKS III. Attach PSAT, PASS scores, MAP scores, EXPLORE scores, and any aptitude / achievement data available for this student. Most recent scores are preferred; earlier scores are not necessary. IV. Please rank this student in comparison with other students his age: Academic motivation Outstanding (top 5%) Excellent (next 10%) Above Below Intellectual ability Interaction with peers Emotional maturity Respect accorded by faculty Perseverance Counselor s Name (First/Last) ( ) Office Telephone Number School Name Counselor s Email Address