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A SUMMER PROGRAM FOR GIFTED AND TALENTED HIGH SCHOOL STUDENTS

GOVERNOR’S SCHOOLNOMINATION PACKET 2012

Governor’s School West | Salem College | Winston-Salem, NC

Governor’s School East | Meredith College | Raleigh, NC

Public Schools of North CarolinaState Board of Education | Department of Public InstructionExceptional Children Divisionwww.ncgovschool.org | 919-807-3986



STATE BOARD OF EDUCATIONThe guiding mission of the North Carolina State Board of Education is that every public school student will graduatefrom high school, globally competitive for work and postsecondary education and prepared for life in the 21st Century.

NC DEPARTMENT OF PUBLIC INSTRUCTIONJune St. Clair Atkinson, Ed.D., State Superintendent301 N. Wilmington Street :: Raleigh, North Carolina 27601-2825

In compliance with federal law, NC Public Schools administers all state-operated educational programs, employment activities andadmissions 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 regarding discrimination issues should be directed to:Dr. Rebecca Garland, Chief Academic Ofcer :: Academic Services and Instructional Support6368 Mail Service Center, Raleigh, NC 27699-6368 :: Telephone: (919) 807-3200 :: Fax: (919) 807-4065

Visit us on the Web :: www.ncpublicschools.org

WILLIAM C. HARRISONChairman :: Fayetteville

WAYNE MCDEVITT

Vice Chair :: Asheville

WALTER DALTONLieutenant Governor :: Rutherfordton

JANET COWELLState Treasurer :: Raleigh

JEAN W. WOOLARDPlymouth

REGINALD KENANRose Hill

KEVIN D. HOWELL

Raleigh

SHIRLEY E. HARRISTroy

CHRISTINE J. GREENEHigh Point

JOHN A. TATE IIICharlotte

ROBERT “TOM” SPEED

Boone

MELISSA E. BARTLETTRoxboro

PATRICIA N. WILLOUGHBYRaleigh

M0910




GOVERNOR’S SCHOOL 2012 Table of Contents

Program Description and Tuition ..................................................................................................................... 1

Area I Curriculum Descriptions ........................................................................................................................ 2

Calendar ............................................................................................................................................................ 3

Frequently Asked Questions ..................................................................................................................... 4 & 5

Eligibility Requirements, Selection Criteria, and Nomination Procedures ........................................... 6 & 7

Audition Requirements ..................................................................................................................................... 8

Public School System Nomination Form .............................................................................................. 9 & 10

Charter/Non-Public/Special School Nomination Form ....................................................................... 11 & 12

Student Application ............................................................................................................................... 13 & 14

Experience Form .................................................................................................................................... 15 & 16

Recommendation Form ........................................................................................................................ 17 & 18

Eligibility and Selection Criteria Form .......................................................................................................... 19

Approved Tests/Instruments .......................................................................................................................... 20

Nomination Packet Checklist ......................................................................................................................... 21




GOVERNOR’S SCHOOL 2012

1

Program Description and Tuition

Program Description The Governor’s School of North Carolina is the oldest statewide summer residential program for gifted and talented high schoolstudents in the nation. The program, which is open to rising seniors only, with exceptions made for rising juniors in selected

performing/visual arts areas, is located on two campuses: Governor’s School West at Salem College in Winston-Salem andGovernor’s School East at Meredith College in Raleigh. Governor’s School West began in 1963 and Governor’s School Eastbegan in 1978. The program is administered by the Public Schools of North Carolina, State Board of Education, Department ofPublic Instruction through the Exceptional Children Division. A Board of Governors, appointed by the State Board of Education,acts as an advisory body.

The program offers a non-credit curriculum for selected students in three areas:

Area I

Area I is the area of the student’s special interestand the basis on which he or she is chosen to attendGovernor’s School. Page 2 presents a summarydescription of the eleven Area I disciplines so that students can envision how they will spend the majority of their class time at the Governor’sSchool. The academic disciplines include English,foreign languages (Spanish at Governor’s SchoolWest and French at Governor’s School East),mathematics, and natural and social sciences. Theperforming/visual arts disciplines include art, choraland instrumental music, dance, and theater. Theemphasis in all disciplines is on contemporary texts,

compositions, artistic expressions, issues, and ideasand the theories that ow from them.

Area IIEach student attends another class comprised of students

from each of the Area I disciplines. Here students and teachers explore connections between the ideas of thesedisciplines. As integrative concepts emerge, the classattempts to construct an understanding of contemporaryways of thinking and of the culture that arises from them.

Area IIIThis third class is also comprised of students from each of the Area I disciplines. Here students attempt to ground what they are learning in their Area I and II classes in their ownpersonal experience. Finally, they apply that understanding to their social worlds; that is, they try to discover links betweenideas and actions, theory and practice.

The academic environment of the Governor’s School thrives upon the intellectual curiosity of students and faculty alike.Students take no tests; teachers assign no grades. Faculty expect students to aspire to be “producers of knowledge, problemsolvers, and problem nders” (Gallagher, 1994). Classes blend intellectual discussion with practical application of theory. Thefaculty and staff at both Governor’s Schools are selected from public school systems, private schools, colleges and universities,and private organizations. On each campus, these people serve as teachers, counselors, and health care, recreational,and ofce personnel. In addition, the campuses are alive with visiting speakers, performances, exhibitions, eldtrips,demonstrations, optional seminars, and lm series. Social and recreational events complement the academic focus.

Tuition Governor’s School traditionally has been fully funded by the General Assembly of North Carolina. Recent economic conditionsresulted in the General Assembly reducing Governor’s School funding for 2010 and 2011, and eliminating funding for 2012. Beginningwith the 2010 Governor’s School, a $500 tuition/student was imposed. Submission of tuition payments is the responsibility of the schoolsystems, charter schools and private schools that nominate students. However, these schools/school systems have great exibilityon how they choose to access and collect tuition funds. This may include requesting families to cover some or all tuition costs.Details on tuition payment options and procedures have been sent to schools and school systems. Families are responsible for the transportation costs to and from the campuses and for their children’s spending money.





2

Area I CurriculumStudy in each Area I discipline emphasizes theory over the memorization of fact, particularly contemporary and progressive theories that stimulate innovative thought in a rapidly changing culture. Courses and activities are designed to stimulate student creativity, movestudents to question basic assumptions, explore unanswered questions, and develop an acceptance of the process of change.

Classes meet twice a day, Monday through Friday, and once on Saturday. (Area II and Area III classes meet three times a week each.)

Art

In the visual arts curriculum, students study and practice visualexpression consistent with current concepts and styles. Emphasis isplaced on creative expression as students investigate and examinemovements and theories in contemporary art.

Choral Music

The choral music curriculum concentrates on music of 20 th and 21st

century composers. Students learn the ner points of choralsinging – blend, diction, tone quality – and vocal techniques in rehearsalsand performance. The aim is to take students from music that is relativelyfamiliar in form and content to repertoire that is quite challengingaesthetically, intellectually, and technically.

Dance

The dance curriculum embraces and expresses 20 th and 21st century theories through daily modern technique classes, a survey of recentpioneers, and the integration of self-expression and abstraction through improvisation, composition, and choreography.

Theater

The goal of the theater curriculum is to introduce young theaterartists to contemporary and progressive theory, literature, and technique. The approach is holistic, encouraging the actor tobecome a well-rounded, life-long student of the theater.

English

The English curriculum focuses on modern and post-modernction, poetry, and drama. The students are encouraged to readclosely, imaginatively, analytically, and empathetically. Some

teachers incorporate creative and analytical writing workshops tohelp students improve their writing.

Foreign Language – French (East)

French students improve their skills in reading and writing, and they examine the emerging literature, music, and art of Frenchcultures. French is the primary language spoken in class.

Foreign Language – Spanish (West)

The goal of Spanish is to expose students to contemporary thought,literature, music, art, and political trends coming from Spain andHispanic America. Spanish is the primary language spoken in class.

Instrumental Music

The focus of instrumental music is the study and performance ofsignicant 20 th and 21st century repertoire for orchestra (West) or wind

ensemble (East), and the creation and performance of student works.The aim is to take students from music that is relatively familiar inform and content to repertoire that is quite challenging aesthetically,intellectually, and technically.

Mathematics

The mathematics program strives to provide an atmosphere forstudents to independently contemplate and investigate problems thatarise in contemporary mathematical elds. In addition, the programprovides many opportunities through student-faculty interaction,seminars, and invited lecturers, for students to gain an appreciationfor both mathematics and the work of mathematicians.

Natural Science

The natural science curriculum investigates contemporary theories and topics of modern science by the use of interactive seminars, discussions,and group and individual problem solving.

Social Science

The social science curriculum examines the major political,sociological, psychological, and anthropological concepts whichhave inuenced the 20 th and 21 st centuries from theoretical and

applied perspectives.

Area I Curriculum Descriptions





3

Governor’s School Calendar

CalendarSeptember 2011

Information regarding 2012 session of Governor’s School mailed to

superintendents, headmasters of non-public schools, charter schooldirectors, EC program directors, AIG coordinators, high school principals,high school counselors, and other Governor’s School contacts.

General information and all necessary forms are posted on the Governor’sSchool website at www.ncgovschool.org.

November 16, 2011

All nominations must be submitted (postmarked) to:

Camilla Roberson, Special AssistantGovernor’s SchoolExceptional Children DivisionNC Department of Public Instruction6356 Mail Service CenterRaleigh, NC 27699-6356

February 11, 2012

Governor’s School Auditions in Choral Music to be held at MeredithCollege in Raleigh. All students who are nominated in this area andwho meet the eligibility requirements for Governor’s School will benotied individually and invited to audition.

February 25, 2012

Governor’s School Auditions in Art, Dance, Instrumental Music, andTheater to be held at Meredith College in Raleigh. All students who arenominated in these areas and who meet the eligibility requirements forGovernor’s School will be notied individually and invited to audition.

March 9, 2012

Notication of students selected to attend the 2012 session of the

Governor’s School is mailed to superintendents, headmasters ofnon-public schools, and the directors of charter schools.

March 16, 2012

Notication of selection/non-selection mailed to students

April 6, 2012 Deadline for nominating schools/school systems to submit acceptanceforms on selected students. Submission of an acceptance formobligates the school/school system to pay a non-refundable tuition of$500 per student. Details on tuition payment options and procedureshave been sent to schools and school systems.

June 17, 2012 Opening day of the 2012 session of the Governor’s School

July 7, 2012 Parents’ Day

July 7 – July 10, 2012 Break in session

July 28, 2012 Last day of the 2012 session of the Governor’s School





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11. What do students do after classes end inthe afternoon?

Governor’s School provides many options for afternoon andevening hours that complement and extend the work of classes.Major outside speakers who are active contributors to currentknowledge in their elds address students once a week. Studentperformances in dance, theater, and music electrify bothcampuses. Daily optional seminars or electives range from theAesthetics of Choreography (dance faculty) to a discussion ofStephen Hawking’s A Brief History of Time (natural science faculty).Several different lm series offer not only substantive lms, butdiscussions that deepen the understanding of the particular lmand sharpen the ability to see and interpret any lm.

12. What kinds of recreational and socialactivities are offered?

Each afternoon and evening, swimming pools, gyms, tennis courts,and elds (for soccer, ultimate frisbee, and softball) are open forindividual and group recreation. Later in the evening, students canchoose social events such as swing dance instruction, ultimatefrisbee tournaments, capture the ag competitions, and scavengerhunts. For many, the high social moments are the masquerade balland, on the nal evening, a semi-formal dance. Others say that theirbest free moments are spent in the spontaneous conversations,gatherings, and activities that students initiate on the benches ofquads and by fountains, at meals and on dormitory halls.

13. How strict are the rules at the Governor’s School? Governor’s School is clearly situated between high school andcollege – a highly ambitious residential school for high schoolstudents. It grants students many freedoms associated withuniversity study, especially the freedom of choice betweenmany different intellectual and community experiences. It is alsogoverned by a number of rules and regulations associated withresidential life for high school students. These are enumerated inan honor code and the Student Handbook – documents mailed withacceptance letters so that students will know what is expected of them before they decide to attend. The Governor’s School is not arule-bound place, but those few rules that exist are taken seriously.Strict adherence to them exercises student self-discipline andresponsibility, insures student safety, and frees the community tofocus on vital and essential new ideas and experiences.

14. Do students have to attend the Governor’s Schoolthe entire six weeks?

Yes. If a student accepts the invitation to attend the Governor’sSchool, he/she must agree to attend for the entire six weeks.(NOTE: Any student who does not stay until the closing session on the last day will not receive a Governor’s School certicate, nor bepermitted to use the Governor’s School experience on college andscholarship applications.) Students are not excused to attend school,family, or community events (i.e., camps, competitions, reunions, etc.).On rare occasions students may be excused for events of greaturgency that cannot be rescheduled. Such requests may only besubmitted after the student selection process.

15. May students go home on weekends?

No. Students must remain at the Governor’s School through the

weekends except the third weekend of the session when all studentsgo home on Saturday and return on the following Tuesday evening.

16. Is there a cost to apply for Governor’s School?

There is no cost to apply for Governor’s School.

17. What is the cost to students to attend theGovernor’s School?

Governor’s School traditionally has been fully funded by the GeneralAssembly of North Carolina. Recent economic conditions resulted in the General Assembly reducing Governor’s School funding for 2010and 2011, and eliminating funding for 2012. Beginning with the 2010Governor’s School, a $500 tuition/student was imposed. Families areresponsible for the transportation costs to and from the campusesand for their children’s spending money. Submission of tuitionpayments will be the responsibility of the Nominating Entity thatnominates students. However, these schools/school systems havegreat exibility on how they choose to access and collect tuitionfunds. This may include requesting families to cover some or all tuition costs. Details on tuition payment options and procedureshave been sent to schools and school systems.

18. Is tuition refundable?

No.

Frequently Asked Questions





6

Eligibility Requirements, Selection Criteria,and Nomination Procedures

The Governor’s School of North Carolina offers a unique residentialexperience to gifted and talented high school students. Students arenominated/selected in the following disciplines:

Art Choral Music DanceEnglish French Spanish Instrumental Music Mathematics Natural ScienceSocial Science Theater

In addition to Area I classes (addressing the discipline in which astudent is nominated), students also participate in Area II and Area IIIclasses. See page 1 for a brief description of the three areas.

Eligibility Requirements 1. Only those students who are legal North Carolina residents or attend

federal schools in the state, and are presently enrolled in the eleventhgrade in North Carolina public schools (e.g., local school districts,charter, federal) or non-public schools (e.g., private, homeschools, etc.)may be nominated. Exceptions for rising junior nominations are madein choral music, dance, and instrumental music.

2. A student must be a legal resident of North Carolina at the timeof attendance.

3. No former Governor’s School student is eligible. However, studentswho are nominated as rising juniors, but are not selected, may berenominated as rising seniors.

4. All students must meet the aptitude/achievement criteria as establishedby the Board of Governors for North Carolina Governor’s School.

a. Most recent aptitude test scores: composite or subtest scoresdocumenting percentile ranges from 92% through 99%.

b. Achievement test scores: composite, subtest, or End-of-Coursescores in appropriate area of nomination shall be used documentingpercentile ranges from 92% through 99%. Scores other than EOCsmust have been given in the 9th, 10th, or 11th grade. Scores from EOC tests taken in the 6th, 7th, and 8th grades will be accepted.

Notes:• Any EOC test may be used for students nominated in Spanish, French,

or the Performing/Visual Arts. Score must be 92 percentile or higher.• Any EOC test in the student’s area of nomination may be used for

students nominated in Math, English, Natural Science, or SocialScience. See notes on page 19. Score must be 92 percentile or higher.

• End of Grade (EOG) tests will not be accepted.

Selection Criteria Multiple criteria are used in the selection process for all Governor’sSchool nominees.

• Scholastic performance: most recent grade in area of nomination (if applicable), class rank (if available), and the most recent transcript

• Personal data:– Two Recommendation Forms*– Two essays– Lists of school and community activities, awards, and honors

* At least one recommendation must be from a high school teacher,preferably in the area of nomination.

Nomination Procedures 1. STUDENT

• Fully completes a Governor’s School Student Application , withall attachments, and submits it to school personnel.

2. SCHOOL PERSONNEL

• High School Staff (often in coordination with the local Governor’sSchool Contact Person):

a. Completes the Eligibility and Selection Criteria Form oneach nominee and has it signed by the high school principal/headmaster.

b. Assembles a complete application (Application Form,essays, Experience Form, Eligibility and Selection CriteriaForm, transcript, and Recommendation Forms removedfrom envelopes) on each nominee and submits it to the highschool principal/school director/headmaster.

• High School Principal/School Director/Headmaster (often incoordination with the local Governor’s School Contact Person):

a. Veries and signs the Eligibility and Selection Criteria Formon each nominee.

b. Recommends (often through a school-based committee) andsubmits complete applications of the outstanding nominees to the Superintendent, when applicable.

• Superintendent/Director/Headmaster (often involving the localGovernor’s School Contact Person):

a. Consults the Nomination Chart to determine the total numberof nominees allowed. See the following exceptions.

(1) French – These nominations are unlimited and do notcount against the number of academic nominations.However, the number of students selected in French isquite small. Consider nominating only those studentswho are very strong in French and can speak it uently.

(2) Instrumental Music and Choral Music – Nominationsfor students who play double-reed instruments (oboeand bassoon), brass instruments (trumpet, Frenchhorn, trombone, euphonium, and tuba), percussioninstruments , or string instruments (violin, viola, cello,bass, and harp), or whose vocal ranges are alto, tenor obass/baritone , are unlimited and will not count against the number of performing/visual arts nominations.

b. Selects the best candidates from the school/school systemfor nomination to the Governor’s School. NOTE: Nominationsshould strive to reect the racial, ethnic, gender andsocioeconomic diversity of the school/school system.

(1) Completes and signs the appropriate Nomination Form (Public School System or Charter/Non-Public/SpecialSchool Nomination Form)





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Eligibility Requirements, Selection Criteria,and Nomination Procedures

(2) Superintendent Choices – Public school systemsuperintendents indicate their two academic choicesin rank order. The student who is ranked rst willautomatically be invited to attend, whereas, the studentwho is ranked second will not automatically be invited toattend. The second choice’s selection will be dependentupon funding. If adequate funding is not available,resulting in fewer academic selections, all secondchoice applications will be reviewed by a SelectionCommittee just as all other academic applications. TheExceptional Children Division recommends that these two students be the top students nominated from theschool system (see Public School System NominationForm). NOTE: Nominees in French and Spanish cannotbe superintendent choices.

c. Assembles and submits one Nomination Packet , whichincludes: one Nomination Form for the entire NominatingEntity and a complete application for each student listed on the Nomination Form.

All nomination packets must be assembled according to thechecklist on page 21, mailed and postmarked by November 16, 2011.

Send to: CAMILLA ROBERSON, SPECIAL ASSISTANTFOR GOVERNOR’S SCHOOLEXCEPTIONAL CHILDREN DIVISIONNC DEPARTMENT OF PUBLIC INSTRUCTION6356 MAIL SERVICE CENTERRALEIGH, NC 27699-6356

Nomination Chart 1. Each Nominating Entity can nominate eligible students

according to the chart below.

2. Superintendent Choices – Each public school system canchoose two eligible academic students (English, Mathematics,Natural Science, or Social Science) to be ranked rst andsecond superintendent choices. The student who is rankedrst will automatically be invited to attend, whereas, thestudent who is ranked second will not automatically beinvited to attend. The second choice’s selection will bedependent upon funding. If adequate funding is not available,resulting in fewer academic selections, all second choiceapplications will be reviewed by a Selection Committee justas all other academic applications.

a. Nominees in French, Spanish or the Performing/VisualArts cannot be Superintendent Choices.

b. Superintendent Choices do count toward the allotted

number of academic nominations.

Nomination Chart

10 th–11 th Grade Total Student Population(Excluding Extended Day Enrollment)

Number of AcademicNominations*

Number of Performing/Visual Arts Nominations**

Up to 125126-250251-500501-800801-11001101-14001401-18001801-21002101-2500

2501-30003001-35003501-40004001-50005001-60006001-80008001-1000010001-15000OVER 15000

12345681012

141720232629323538

24681012162022

242628303234363840

* Limits on academic nominationsonly pertain to English, Mathematics,Natural Science, Social Science,and Spanish. Nominations inFrench are unlimited.

Note: See page 6 for more informationon French nominations.

** Limits on performing/visual artsnominations do not include students whoplay double-reed instruments (oboe andbassoon), brass instruments (trumpet,French horn, trombone, euphonium, and tuba), percussion instruments, or stringinstruments (violin, viola, cello, bass, andharp), or whose vocal ranges are alto, tenor, or bass/baritone.





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Audition Requirements

Students are allowed to audition in one area only and will receive information about audition procedures(location, time, date, preparations, etc.) several weeks prior to audition day.

Art All nominees must bring three of their best works of art in any medium that show drawing, painting, sculpting, ceramic, or printmaking skills.The three pieces may be in the same medium. Each piece is limited to36 inches in width and height. Framed artwork will not be accepted;matting is allowed. Space is limited; therefore, no easels or props arepermitted. During the judging, nominees must stand by their artwork to answer questions about their work. Informal questions may beasked to help the nominee feel at ease. Any other questions askedwill be related to the student’s artwork. Nominees must stay untildismissed by the judges.

Dance

All nominees will audition together in a modern dance class; therefore,a prepared routine is not necessary. Dance nominees should wearpractice clothing only (leotards and tights for females; dance or yogapants and t-shirt or tank for males). All clothes should be form tting.Ballet shoes are not to be worn; nominees will be auditioning in theirbare feet. No costumes will be necessary. Nominees should put their hair up and not wear jewelry. Informal questions may be asked to help the nominee feel at ease. Any other questions asked will beperformance related. Nominees must stay until dismissed by the judges.

TheaterYou should be prepared to present a memorized selection not to exceed

two minutes either from classical material (prose or poetry) or from amodern play. You do not need to bring a copy of the selection. Selectmaterial which is best suited to your particular ability and demonstratesyour range. (The judges will be interested in seeing more than a one-dimensional monologue.) If you are portraying a character, choosesomeone close to your own age and gender. No costumes or propsare necessary. You will be auditioning in a classroom – not on a stage.Students who also have an interest in theater tech should bring aresumé or portfolio of lighting or set design/building achievements toshare with the judges. Informal questions may be asked to help you feelat ease. Any other questions asked will be performance related.

Choral Music Choral music nominees should be prepared to sing a piece of their ownchoosing not to exceed two minutes. Nominees should consult with their music teacher for a piece suitable for their voice. Nominees mustbring two originals of their selection to auditions. One original willbe used by the nominee and the second original will be used by thejudge. Photocopies will not be allowed under any circumstance due tocopyright laws. Nominees arriving for auditions with only one originalof their selection must be prepared to sing their selection by memory. NO EXCEPTIONS CAN BE MADE. All nominees will be asked to sight-reada selection chosen by the judge and may be asked to perform scales to determine vocal range. If a nominee wishes to use an accompanist,he/she should bring someone. Parents may not accompany theirchildren. If a nominee wishes to use recorded music, he/she must

bring the recording and any equipment necessary to play it, includingspeakers. (Note: Internet access will not be available.) Informalquestions may be asked to help the nominee feel at ease. Any otherquestions asked will be performance related.

Instrumental Music Instrumental music nominees should be prepared to play a piece of theirown choosing not to exceed two minutes. Nominees should consult with their music teachers or band directors for a piece which displays their technical and musical abilities. Nominees must bring two originals of theirselection to auditions. One original will be used by the nominee and thesecond original will be used by the judge. Photocopies will not be allowedunder any circumstance due to copyright laws. Nominees arriving forauditions with only one original of their selection must be prepared to play their selection by memory. NO EXCEPTIONS CAN BE MADE.All nomineeswill be asked to sight-read a selection chosen by the judge. No scales arerequired. Nominees must bring their own instrument except those nomineesauditioning on the mallet percussion and timpani. Instrumentalists areexpected to perform unaccompanied. The following instruments will beauditioned: Flute/Piccolo, Oboe/English Horn, Clarinet (E-at, B-at, Alto,Bass, Contralto, and Contrabass), Saxophone (Alto, Tenor, and Baritone),Bassoon, Trumpet, French Horn, Trombone, Euphonium, Tuba, Percussion,Violin, Viola, Cello, Bass, and Harp. No other instruments will be auditionedInformal questions may be asked to help the nominee feel at ease. Any otherquestions asked will be performance related.





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Public School System Nomination Form

Public School System

Contact Name Title

Mailing Address

Telephone Fax Email

Signature of Superintendent Date

CONTINUED

PAGE 1 OF 2

Total Tenth and Eleventh Grade Enrollment(Omit Extended Day Enrollment) _____________________

Tenth and Eleventh GradeRacial Composition _____% white; _____% nonwhite

Total Nominations ________ ( _____% white; _____% nonwhite)

Please list below all students from your administrative unit nominated for the Governor’s School.The superintendent is to indicate the two Superintendent Choices by placingthe students’ names by the rankings (1st or 2nd) below. Nominees in French and Spanish cannot be Superintendent Choices. The remaining nominations in academics neednot be listed in rank order. Beside each name indicate gender, race, nomination area for academics, voice part for choral music, and instrument for instrumental music.

* Not automatically invited to attend.

LIMITED ACADEMICS (Rising Seniors Only)English, Mathematics, Natural Science, Social Science, Spanish

name gender/race nomination area1st2nd*

UNLIMITED ACADEMICS (Rising Seniors Only)French (These are in addition to the number allowed on p. 7.)

name gender/race nomination area

ART (Rising Seniors Only)

name gender/race

Number of Academic Nominations _________ _________ Number of Performing/Visual Arts Nominations _________ _________limited limited unlimited unlimited





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Public School System Nomination FormPAGE 2 OF 2

DANCE (Rising Juniors or Seniors)name gender/race

LIMITED CHORAL MUSIC (Rising Juniors or Seniors)

soprano I and II only

name gender/race voice part

LIMITED INSTRUMENTAL MUSIC (Rising Juniors or Seniors)

ute/piccolo, clarinet, and saxophone only name gender/race instrument

THEATER (Rising Seniors Only) name gender/race

UNLIMITED CHORAL MUSIC (Rising Juniors or Seniors)

alto, tenor, and bass/baritone voices(These are in addition to the number allowed on page 7.)


UNLIMITED INSTRUMENTAL MUSIC (Rising Juniors or Seniors)

double-reed instruments (oboe and bassoon), brass instruments(trumpet, French horn, trombone, euphonium, and tuba), percussioninstruments, or string instruments (violin, viola, cello, bass, and harp)

(These are in addition to the number allowed on page 7.)

name gender/race instrument





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Charter/Non-Public/Special SchoolNomination Form

CONTINUED

Please list below all students from your school nominated for the Governor’s School. The nominations need not be listed in rank order. Beside each

name indicate gender, race, nomination area for academics, voice part for choral music, and instrument for instrumental music.

LIMITED ACADEMICS (Rising Seniors Only)English, Mathematics, Natural Science, Social Science, Spanish


UNLIMITED ACADEMICS (Rising Seniors Only)French (These are in addition to the number allowed on p. 7.)


ART (Rising Seniors Only)

name gender/race

Charter/Non-Public/Special School

Contact Name Title

Mailing Address

Telephone Fax Email

Signature of Headmaster/Director Date

PAGE 1 OF 2

Total Tenth and Eleventh Grade Enrollment(Omit Extended Day Enrollment) _____________________

Tenth and Eleventh GradeRacial Composition _____% white; _____% nonwhite

Total Nominations ________ ( _____% white; _____% nonwhite)

Number of Academic Nominations _________ _________ Number of Performing/Visual Arts Nominations _________ _________limited limited unlimited unlimited





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PAGE 2 OF 2

Charter/Non-Public/Special SchoolNomination Form

DANCE (Rising Juniors or Seniors)name gender/race

LIMITED CHORAL MUSIC (Rising Juniors or Seniors)

soprano I and II only


LIMITED INSTRUMENTAL MUSIC (Rising Juniors or Seniors)

ute/piccolo, clarinet, and saxophone only name gender/race instrument

THEATER (Rising Seniors Only) name gender/race

UNLIMITED CHORAL MUSIC (Rising Juniors or Seniors)

alto, tenor, and bass/baritone voices(These are in addition to the number allowed on page 7.)


UNLIMITED INSTRUMENTAL MUSIC (Rising Juniors or Seniors)

double-reed instruments (oboe and bassoon), brass instruments(trumpet, French horn, trombone, euphonium, and tuba), percussioninstruments, or string instruments (violin, viola, cello, bass, and harp)

(These are in addition to the number allowed on page 7.)

name gender/race instrument





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Student Application STAPLE – NO PAPER CLIPS PAGE 1 OF 2

FORM MAY BE COPIED

1. BASIC INFORMATION AND DEMOGRAPHIC DATA

Name ____________________________________________________________________________________________________________ First Middle Initial Last

Preferred Name ______________________________________________________ Age _______ Sex _______ Race _______

Mailing Address __________________________________________________________________________________________________ Street or Box No. City Zip Code

Telephone ( _______ ) ____________________________ Last Four Digits of Social Security Number ______________________

Public County or City School System ________________________________________________________________________________

Public High School ______________________________________________________________________________ Grade _________

Charter or Non-Public High School County ____________________________________________________________________________Charter or Non-Public High School ________________________________________________________________ Grade _________

2. NOMINATION AREA – Indicate only one area

Academics (Rising Seniors only; check one specic area) ___ English___ Mathematics___ Natural Science___ Social Science___ Spanish___ French

Performing/Visual Arts (Check one specic area) ___ Art (Rising Seniors only) ___ Dance (Rising Juniors or Seniors) ___ Theater (Rising Seniors only) ___ Choral Music (Rising Juniors or Seniors)

List Voice Part _______________________________(Soprano I, II; Alto; Tenor; Bass/Baritone – List only one)

___ Instrumental Music (Rising Juniors or Seniors) List Instrument ______________________________

3. STATEMENT OF INTENT

My signature indicates my wish to be considered as a Governor’s School nominee. I understand that I will be identied asa Governor’s School nominee only if determined by the local nominating committee. I understand that if I am selected bythe State, and if I accept, I will attend the entire six-week program. I further understand that no exceptions will be madefor family reunions, cheerleading camps, sports activities, and the like.

____________________________________________________ ____________________________________________________ Signature of Student Date Signature of Parent/Guardian Date

Notes • Students in M t em ti s must ve ompleted Algebra II or Integrated Math III before the2012 session begins.

• Students in Sp nis nd F en must ve ompletedat least two years of study in these courses beforethe 2012 session begins.

Academics Performing/Visual Arts

Notes • Inst uments offe ed e: Flute/Pi olo, Oboe/En lisHorn, Clarinet (E-Flat, B-Flat, Alto, Bass, Contralto, andContrabass), Saxophone (Alto, Tenor, and Baritone),Bassoon, Trumpet, French Horn, Trombone, Euphonium,Tuba, Percussion, Violin, Viola, Cello, Bass, and Harp.

• Pi no nd uit e not offe ed.





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Student Application PAGE 2 OF 2

FORM MAY BE COPIED

4. ESSAYS

Please write two essays as directed below. Type each essay on a separate page and clearly label each page with yourname and the essay topic and, for Essay Two, the Area you have chosen. Please limit each essay to one page only,

single or double spaced.Essay OneIdentify nd dis uss one si ni nt p oblem o issue in ontempo y ultu e t t on e ns you: some of t e dimensionsof this issue, why it matters to you, and what possible solutions you or others might propose to deal with it.

Essay TwoIn this essay, local and state selection committee members hope to gain a clearer insight into an applicant’s interest inthe Area I eld of nomination. If you know your Area I eld of nomination, choose the topic for that discipline. If you donot yet know your Area I eld of nomination, choose the topic that is closest to your deepest interests.

• Nominees in English and Performing/Visual Arts: Describe the relevance of a 20th or 21st century work of art orliterature and detail how it has inuenced your thoughts and/or action.

• Nominees in Natural Science and Social Science: Discuss an important 20th or 21st century idea in natural scienceor social science and explain how it has inuenced your thoughts and/or action.

• Nominees in Mathematics: Des ibe you esponse to t e followin quote: “T e t ue spi it of deli t…is to befound in mathematics as surely as in poetry.” – Bertrand Russell

• Nominees in Spanish and French: Describe your interest in the Spanish or French language. Please include anypersonal experiences specically related to foreign language and culture and how they inspired you to explore theSpanish or French-speaking world.

5. EXPERIENCE

Please respond to the following requests. Type responses on the Experience Form and clearly label each page with your name.

1. List school and community activities, awards, and honors you have participated in or received during the pastthree years, and tell why any two are important to you.

2. List residential schools (such as Summer Ventures, NC School of Science and Math) you have attended and when.

6. RECOMMENDATIONS

Two Recommendation Forms (pages 17 and 18) must be completed by persons who know the nominee’s strengths in thearea of nomination and can address the nominee’s intellectual curiosity, love of learning, and potential to prot from theGovernor’s School experience. No parent or student should submit a recommendation. At least one recommendation should be from a high school teacher, preferably in the area of nomination.





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School and Community Activities during the past three years.____________________________________________________

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PAGE 1 OF FORM MAY BE COPIE

Name of Student _______________________________________________________________________________________________________________________

Experience Form





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Name of Student _______________________________________________________________________________________________________________________

Tell why any two of these activities, awards or honors are important to you.

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Residential Schools attended and where:

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PAGE 2 OF 2FORM MAY BE COPIED

Experience Form





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Recommendation Form

Student’s Name ____________________________________Nomination Area ___________________

School _______________________________ School System _________________________________

Subjects you have taught this nominee if you are a teacher: ____________________________ __________(preferably in the student’s area of nomination)

9 th grade ___________________10 th grade ____________________11 th grade ____________________How long have you known this student? ________________

DIRECTIONS: In Sections A & B choose the numbers that indicate your perception of this student. Please elaborate in the spaceprovided. We are interested in knowing what is unique about this student. In Section C answer the questions and elaborate.

N/A=Not Applicable 1=Poor 2=Acceptable 3=Good 4=Very Good 5=Superior

A. What do you consider this student’s particular strengths, weaknesses, and potential as a student?To what degree does this student demonstrate:

1.

2.

3.

4.5.

6.

7.

8.

9.

10.

11.

High level of interest in and commitment to the subject of nomination

High level of ability in this subject

Openness to new ide s nd llen in m te i l

Ability to synthesize ideasAbility to grasp underlying principles

Capacity to examine multiple ideas or solutions to problems or questions

Ability to work constructively on a task with independence and commitmentfor an extended period of time

Capacity and willingness to examine assumptions

Work of high quality

Creativity

Motivation

N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5

N/A 1 2 3 4 5

Please elaborate on the information above:

AT LEAST ONE RECOMMENDATION MUST BE FROM A HIGH SCHOOLTEACHER, PREFERABLY IN THE AREA OF NOMINATION

PAGE 1 OF 2

CONTINUED





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N/A=Not Applicable 1=Poor 2=Acceptable 3=Good 4=Very Good 5=Superior

B. How would you evaluate this student’s stability, character, maturity, and attitude towards peers, teachers, and others?To what degree does the student demonstrate:

11.

2.

3.

4.1

5.

6.

7.

8.

Cooperation with teachers and others

Honesty, helpfulness, and consideration of others

Ability to listen to and interact with classmates

Empathy for other classmates

Social and emotional maturity

Individual responsibility

Potential for growth

Adaptability in new situations

N/A 1 2 3 4 5

N/A 1 2 3 4 5

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N/A 1 2 3 4 5

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C. Are you condent that this student:

• is inquisitive, se ious, nd exible enou to ente t in spe ul tive questions YES NO and to push intellectual boundaries?

• n independently fun tion t i level fo six weeks w y f om ome YES NO in a challenging academic and residential environment?


____________________________________________________ ____________________________________________________ Signature Date Title

The information provided is condential and will be read only by persons responsible for student selection and faculty and staff of the Governor’s School.

Recommendation FormPAGE 2 OF 2





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Eligibility and Selection Criteria FormFORM MAY BE COPIE

To be Completed by School PersonnelRefer to page 20 for Approved Tests/Instruments. (Do not use abbreviations when indicating test. Use full test name.)

Name of Student _________________________________________________________________________________________

Academic Aptitude Criteria (Most recent test data are required)

1. Indicate most recent Aptitude Test name: ____________________________________________________________________________

2. Indicate Type of Score: Composite _______________________________ or Subtest (specify) _______________________________

3. Write year test was given: _____________________________

4. Indicate percentile score: 92, 93, 94, 95, 96, 97, 98 or 99

Academic Achievement Criteria (Must use test data from 9 th , 10 th or 11th grade*)

1. Indicate Achievement Test name: _________________________________________________________________________________ _

2. Indicate Type of Score: Composite _______________________________ or Subtest (specify) _______________________________

or End-of-Course Test (see notes below) (specify) _______________________________

3. Write year test was given: _____________________________

4. Indicate percentile score: 92, 93, 94, 95, 96, 97, 98 or 99

NOTES: Any EOC test may be used for students nominated in Spanish, French, or the Performing/Visual Arts. Score must be 92 percentile or higher.

Any EOC test in the student’s area of nomination may be used for students nominated in Math (Algebra I, Algebra II, or Geometry), English (English I),Natural Science (Physical Science, Biology, Chemistry, or Physics), Social Science (Civics and Economics or US History). The score must be92 percentile or higher.

* If the student has taken an EOC test, but does not have a readily accessible percentile score, contact the LEA Testing Coordinator.* Tests other than EOCs must have been given in the 9 th, 10 th, or 11 th grade. Scores from EOC tests taken in the 6 th, 7 th, and 8 th grades will be accepted. * End of Grade test scores will not be accepted.

Scholastic Performance Criteria

1. Indicate most recent grade in area of nomination: (if applicable) ____________

2. Indicate class rank (if available) ____________ of ____________

3. Transcript (most current)

_____________________________________________________________________________ ___________________________ Signature of Principal/Headmaster Date

_________________________________________________________________________________________________________________ Public School Administrative Unit/Non-Public/Special School

NOTE: Applications with aptitude and achievement scoresbelow 92 percentile will not be considered for selection.

NOTE: Applications with aptitude and achievement scoresbelow 92 percentile will not be considered for selection.





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Approved Tests/Instruments

Aptitude ❑ Cognitive Abilities Test (CogAT)

❑

Comprehensive Test of Non-Verbal Intelligence II(CTONI-2)

❑ Differential Ability Scales 2 (DAS-II)

❑ InView

❑ Kaufman Assessment Battery for Children II (KABC-II)

❑ Naglieri Nonverbal Ability Test I & II (NNAT & NNAT 2)

❑ Otis-Lennon School Ability Test (OLSAT-8)

❑ Raven’s Progressive Matrices

❑ Reynolds Intellectual Assessment Scales (RIAS)

❑ Scholastic Abilities Test for Adults, AptitudePortion (SATA)

❑ Stanford-Binet 5

❑ Universal Non-Verbal Intelligence Test (UNIT)

❑ Wechsler Scales:• Wechsler Intelligence Scale for Children III

(WISC III) Note: Accepted date ranges for theWISC III are administrations before 2005. Any useof the WISC III after 2004 will not be accepted.

• Wechsler Intelligence Scale for Children IV (WISC IV) • Wechsler Adult Intelligence Scale III (WAIS III)

NOTE: Accepted date ranges for the WAIS III areadministrations before 2010. Any use of the WAIS IIIafter 2009 will not be accepted.

• Wechsler Adult Intelligence Scale IV (WAIS IV)

❑ Woodcock-Johnson Tests of Cognitive Ability (WJ-III Cog)

Achievement ❑ American College Test (ACT)

❑

Comprehensive Testing Program (CTP4/ERB)❑ End-of-Course (North Carolina)

❑ Iowa Test of Basic Skills (ITBS)

❑ Iowa Test of Educational Development (ITED)

❑ Kaufman Test of Educational Achievement (KTEA)NOTE: Accepted date ranges for the KTEA areadministrations before 2004. Any use of the KTEA after2003 will not be accepted.

❑ Kaufman Test of Educational Achievement II (KTEA 2)

❑

Metropolitan Achievement Test 8❑ Scholastic Abilities Test for Adults, Achievement

Portion (SATA)

❑ Scholastic Assessment Test (SAT)

❑ Stanford Achievement Test 10

❑ TerraNova

❑ Test of Reading Comprehension III (TORC 3)NOTE: Accepted date ranges for the TORC 3 areadministrations before 2010. Any use of the TORC 3after 2009 will not be accepted.

❑ Test of Reading Comprehension IV (TORC 4)

❑ Wechsler Individual Achievement Test II (WIAT II)

❑ Wechsler Individual Achievement Test III (WIAT III)

❑ Woodcock-Johnson Tests of Achievement (WJ-III ACH)

NOTES: The latest editions of these tests should be used. The Exceptional Children Division of theNC Department of Public Instruction must be contacted for approval of any tests not listed here.





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Nomination Packet Checklist

This checklist is included for your convenience. Check off each item as it is completed.

1. PUBLIC OR CHARTER/NON-PUBLIC/SPECIAL SCHOOL NOMINATION FORM (ONE FOrM PEr NOMINaTINg ENTITY)

signature of Superintendent or Headmaster/Director school unit name

contact name, address and phone numberSuperintendent Choices (public school systems & federal schools only)race and gendernominated students coincide with Nomination Chart

2. APPLICATION FORM (FOr Each NOMINEE)

signatures (statement of intent) identifying information

school unit and high schoolnomination choicetwo typed essays

3. EXPERIENCE FORM (FOr Each NOMINEE)

school and community activities awards and honors residential schools

4. ELIGIBILITY AND SELECTION CRITERIA FORM (FOr Each NOMINEE)

signatures school name

approved academic aptitude test/instruments using most recent test scoresapproved academic achievement test/instruments

grade in area of nomination and class rank transcript attached

5. RECOMMENDATION FORMS (FOr Each NOMINEE)

two recommendation forms (removed from envelopes and stapled to application)

6. ORDER FOR EACH STUDENT APPLICATION E ppli tion st pled (no p pe lips) nd p esented in t e followin o de : 1. Application Form

2. typed essays 3. Experience Form

4. Eligibility and Selection Criteria Form5. transcript

6. two Recommendation Forms (removed from envelopes)7. DEADLINE Each nomination packet (Nomination Form and Applications) assembled and postmarked by November 16, 2011.

M il to: c mill robe son, Spe i l assist nt fo gove no ’s S ool Exceptional Children Division | NC Department of Public Instruction6356 Mail Service Center | Raleigh, NC 27699-6356

DO NOT SEND THIS CHECKLIST WITH APPLICATIONS.

govenor's shcool complete-packet

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