governament school complete packet 2013

8/11/2019 Governament School Complete Packet 2013

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A SUMMER PROGRAM FOR GIFTED AND TALENTED HIGH SCHOOL STUDENTS

GOVERNORS SCHOOLNOMINATION PACKET 2013

Governors School West | Salem College | Winston-Salem, NC

Governors 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


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STATE BOARD OF EDUCATIONThe guiding mission of the North Carolina State Board of Education is that every public school student will graduate

from 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 Superintendent

301 N. Wilmington Street :: Raleigh, North Carolina 27601-2825

In compliance with federal law, NC Public Schools administers all state-operated educational programs, employment activities and

admissions 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 Officer :: Academic Services and Instructional Support

6368 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. HARRISON

Chairman :: Fayetteville

WAYNE MCDEVITT

Vice Chair :: Asheville

WALTER DALTON

Lieutenant Governor :: Rutherfordton

JANET COWELL

State Treasurer :: Raleigh

JEAN W. WOOLARD

Plymouth

REGINALD KENAN

Rose Hill

KEVIN D. HOWELL

Raleigh

SHIRLEY E. HARRIS

Troy

CHRISTINE J. GREENE

High Point

JOHN A. TATE III

Charlotte

ROBERT TOM SPEED

Boone

MELISSA E. BARTLETT

Roxboro

PATRICIA N. WILLOUGHBY

Raleigh

M0910


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A SUMMER PROGRAM FOR GIFTED AND TALENTED HIGH SCHOOL STUDENT

GOVERNORS SCHOOL 2013 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


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GOVERNORS SCHOOL 2013

1

Program Description and Tuition

Program Description

The Governors School of North Carolina is the oldest statewide summer residential program for gifted and talented high school

students 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: Governors School West at Salem College in Winston-Salem andGovernors School East at Meredith College in Raleigh. Governors School West began in 1963 and Governors School East

began in 1978. The program is administered by the Public Schools of North Carolina, State Board of Education, Department of

Public 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 students special interest

and the basis on which he or she is chosen to attend

Governors School. Page 2 presents a summary

description of the eleven Area I disciplines so

that students can envision how they will spend

the majority of their class time at the Governors

School. The academic disciplines include English,

foreign languages (Spanish at Governors School

West and French at Governors School East),

mathematics, and natural and social sciences. The

performing/visual arts disciplines include art, choral

and instrumental music, dance, and theater. The

emphasis in all disciplines is on contemporary texts,

compositions, artistic expressions, issues, and ideas

and the theories that flow from them.

Area II

Each 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 class

attempts to construct an understanding of contemporary

ways of thinking and of the culture that arises from them.

Area III

This 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 own

personal experience. Finally, they apply that understanding to

their social worlds; that is, they try to discover links between

ideas and actions, theory and practice.

The academic environment of the Governors 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, problem

solvers, and problem finders (Gallagher, 1994). Classes blend intellectual discussion with practical application of theory. The

faculty and staff at both Governors 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 office personnel. In addition, the campuses are alive with visiting speakers, performances, exhibitions, fieldtrips,

demonstrations, optional seminars, and film series. Social and recreational events complement the academic focus.

Tuition

Governors School traditionally has been fully funded by the General Assembly of North Carolina. Recent economic conditions resulted

in the General Assembly reducing Governors School funding for 2010 and 2011 and eliminating all funding for 2012. During the

2012 legislative session, partial funding was restored for the 2013 Governors School. Beginning with the 2010 Governors School,

a $500 tuition/student was imposed. State funding and tuition will support the 2013 Governors School session. Submission of tuition

payment is the responsibility of the school systems, charter schools and private schools that nominate students. However, these schools/

school systems have great flexibility on how they choose to access and collect tuition funds. This may include requesting families

to cover some or all of the tuition costs. Details on tuition payment options and procedures have been sent to schools and school

systems. Scholarships will be available through the NC Governors School Foundation www.ncgsfoundation.org/scholarships/.


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2

Area I Curriculum

Study 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, move

students 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 visual

expression consistent with current concepts and styles. Emphasis is

placed on creative expression as students investigate and examine

movements and theories in contemporary art.

Choral Music

The choral music curriculum concentrates on music of 20thand 21st

century composers. Students learn the finer points of choralsinging blend, diction, tone quality and vocal techniques in rehearsals

and performance. The aim is to take students from music that is relatively

familiar in form and content to repertoire that is quite challenging

aesthetically, intellectually, and technically.

Dance

The dance curriculum embraces and expresses 20thand 21stcentury

theories through daily modern technique classes, a survey of recent

pioneers, and the integration of self-expression and abstraction

through improvisation, composition, and choreography.

Theater

The goal of the theater curriculum is to introduce young theater

artists to contemporary and progressive theory, literature, and

technique. The approach is holistic, encouraging the actor to

become a well-rounded, life-long student of the theater.

English

The English curriculum focuses on modern and post-modern

fiction, poetry, and drama. The students are encouraged to read

closely, 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 French

cultures. 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 and

Hispanic America. Spanish is the primary language spoken in class.

Instrumental Music

The focus of instrumental music is the study and performance of

significant 20thand 21stcentury 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 in

form and content to repertoire that is quite challenging aesthetically,

intellectually, and technically.

Mathematics

The mathematics program strives to provide an atmosphere for

students to independently contemplate and investigate problems that

arise in contemporary mathematical fields. In addition, the program

provides many opportunities through student-faculty interaction,

seminars, and invited lecturers, for students to gain an appreciation

for 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 which

have influenced the 20th and 21st centuries from theoretical and

applied perspectives.

Area I Curriculum Descriptions


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Governors School Calendar

Calendar

September 2012

Information regarding 2013 session of Governors School mailed to

superintendents, headmasters of non-public schools, charter schooldirectors, EC program directors, AIG coordinators, high school principals,

high school counselors, and other Governors School contacts.

General information and all necessary forms are posted on the Governors

School website at www.ncgovschool.org.

November 14, 2012

All nominations must be submitted (postmarked) to:

Camilla Roberson, Special Assistant

Governors School

Exceptional Children Division

NC Department of Public Instruction

6356 Mail Service CenterRaleigh, NC 27699-6356

February 9, 2013

Governors School Auditions in Art, Choral Music, Dance and Theater to

be held at Meredith College in Raleigh. All students who are nominated

in these areas and who meet the eligibility requirements for Governors

School will be notified individually and invited to audition.

February 23, 2013

Governors School Auditions in Instrumental Music to be held at

Meredith College in Raleigh. All students who are nominated in this area

and who meet the eligibility requirements for Governors School will be

notified individually and invited to audition.

March 7, 2013

Notification of students selected to attend the 2013 session of the

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

March 14, 2013

Notification of selection/non-selection mailed to students

April 4, 2013

Deadline for nominating schools/school systems to submit acceptance

forms on selected students. Submission of an acceptance form

obligates the school/school system to pay a non-refundable tuition of

$500 per student. Details on tuition payment options and procedures

have been sent to schools and school systems.

June 16, 2013

Opening day of the 2013 session of the Governors School

July 4, 2013

Parents Day

July 4 July 7, 2013

Break in session

July 20, 2013

Last day of the 2013 session of the Governors School


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1. Where is the Governors School located?

The Governors School has two sites: G. S. West is located on

the campus of Salem College in Winston-Salem and G. S. East

is located on the campus of Meredith College in Raleigh.

2. May students request which campus they would

like to attend and request roommates?

No. Students and roommates are randomly assigned. Students mustattend the campus to which they are assigned.

3. Are the programs the same at Governors

School East and West?

Yes, except that Governors School West offers Spanish and an

orchestra and Governors School East offers French and a wind

ensemble. Otherwise the curriculum of both schools is the same.

4. How are students nominated for theGovernors School?

The nomination process has multiple steps at the school and district

levels. In individual schools, teachers, principals, and counselors

nominate applicants to the local public school superintendent or

private school headmaster. (If a discipline studied at the Governors

School is not offered in an individual high school, a student may

request to be nominated in that discipline. All applicants must meet the

criteria established for the N.C. Governors School.) The Nominating

Entity (i.e., public school system, charter school, non-public school, or

special school) determines which of its nominees will be sent for final

selection at the state level.

5. How are nominated students selected to attendthe Governors School?

The process varies, depending on the area of nomination.

To ensure statewide representation of students, public school

system superintendents nominate one academic area student.

This student will automatically be invited to attend. The selection

committee chooses the remaining academic students, just as

college admissions committees choose among college applicants.

French and Spanish applications are also reviewed by the

selection committee. In addition, applicants may be contacted for

phone interviews with selection committee members to ensure

adequate language competency, as classes are conducted

entirely in French and Spanish.

Performing and visual arts students selection is determined by

audition before judges complemented by the students applications.

6. Is the number of nominations limited?

Yes. Each Nominating Entity is allotted a certain number of

nominations based on its tenth and eleventh grade student

population, with exceptions in French and certain performing arts

areas. (See page 7 for details of this allocation.)

7. May the performing/visual arts students auditionin more than one area?

No. They may only audition in one area of nomination.

8. How do I get information about auditions?

The Department of Public Instruction will mail specific information

about auditions directly to individual nominees in January, about four

weeks prior to auditions. Those letters will include instructions about

the audition day, audition times and places (buildings), and directions toMeredith College (the audition site).

9. How is a typical Governors School class conducted?

Highly energized and committed teachers invite students to explore

new and significant ideas, not principally through lecture but

through discussion. Teachers may use an occasional mini-lecture to

present a formula in math or physics, demonstrate a new movement

in art or music, or explain a recent theory of social groups or literary

texts. But the hallmark of our intellectual work is the interplay

between theory and students responses, between the abstract and

the personal. Without the common burdens of covering a defined

body of material and being tested on it, students and teachers can

forge a safe, non-competitive intellectual environment where ideas

from many disciplines are entertained and all active learners are

taken seriously.

10. What kinds of dance, theater, and music

are performed?

The emphasis throughout the arts (and academic) curriculum is

on modern and contemporary ideas and forms of expression. This

emphasis has been one of the most successful parts of this 50 year old

program for several reasons: it surprises and energizes students with

its often unexpected uniqueness; it alerts students to current ideas; itencourages students and teachers to become creative explorers of

uncharted territory; it introduces intellectual inquiries that often do not

come into view until advanced college and graduate study.

Frequently Asked Questions

CONTINUED


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11. What do students do after classes end in

the afternoon?

Governors School provides many options for afternoon and

evening hours that complement and extend the work of classes.

Major outside speakers who are active contributors to current

knowledge in their fields address students once a week. Student

performances in dance, theater, and music electrify both

campuses. Daily optional seminars or electives range from the

Aesthetics of Choreography (dance faculty) to a discussion of

Stephen HawkingsA Brief History of Time(natural science faculty).

Several different film series offer not only substantive films, but

discussions that deepen the understanding of the particular film

and sharpen the ability to see and interpret any film.

12. What kinds of recreational and social

activities are offered?

Each afternoon and evening, swimming pools, gyms, tennis courts,

and fields (for soccer, ultimate frisbee, and softball) are open for

individual and group recreation. Later in the evening, students can

choose social events such as swing dance instruction, ultimate

frisbee tournaments, capture the flag competitions, and scavenger

hunts. For many, the high social moments are the masquerade ball

and, on the final evening, a semi-formal dance. Others say that their

best free moments are spent in the spontaneous conversations,

gatherings, and activities that students initiate on the benches of

quads and by fountains, at meals and on dormitory halls.

13. How strict are the rules at the Governors School?Governors School is clearly situated between high school and

college a highly ambitious residential school for high school

students. It grants students many freedoms associated with

university study, especially the freedom of choice between

many different intellectual and community experiences. It is also

governed by a number of rules and regulations associated with

residential life for high school students. These are enumerated in

an honor code and the Student Handbook documents mailed with

acceptance letters so that students will know what is expected of

them before they decide to attend. The Governors School is not a

rule-bound place, but those few rules that exist are taken seriously.

Strict adherence to them exercises student self-discipline and

responsibility, insures student safety, and frees the community to

focus on vital and essential new ideas and experiences.

14. Do students have to attend the Governors School

the entire five weeks?

Yes. If a student accepts the invitation to attend the Governors

School, he/she must agree to attend for the entire five weeks.

(NOTE: Any student who does not stay until the closing session on

the last day will not receive a Governors School certificate, nor be

permitted to use the Governors School experience on college and

scholarship 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 great

urgency that cannot be rescheduled. Such requests may only be

submitted after the student selection process.

15. May students go home on weekends?

No. Students must remain at the Governors School through the

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

16. What is the cost to students to attend theGovernors School?

Tuition is $500 per student. Submission of tuition payment is the

responsibility of the school systems, charter schools and private

schools that nominate students. However, these schools/school

systems have great flexibility on how they choose to access and

collect tuition funds. This may include requesting families to cover

some or all of the 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 childrens spending money.

17. Are scholarships available?

Yes. Scholarship information can be found at

www.ncgsfoundation.org/scholarships/.

18. Is tuition refundable?

No.

Frequently Asked Questions


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6

Eligibility Requirements, Selection Criteria,and Nomination Procedures

The Governors School of North Carolina offers a unique residential

experience to gifted and talented high school students. Students are

nominated/selected in the following disciplines:

Art Choral Music DanceEnglish French SpanishInstrumental Music Mathematics Natural Science

Social Science Theater

In addition to Area I classes (addressing the discipline in which a

student is nominated), students also participate in Area II and Area III

classes. See page 1 for a brief description of the three areas.

Eligibility Requirements

1. Only those students who are legal North Carolina residents (exchange

students are not eligible) or attend federal schools in the state, and are

presently enrolled in the eleventh grade 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 made in choral music, dance, and instrumental music.

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

of attendance.

3. No former Governors School student is eligible. However, students

who are nominated as rising juniors, but are not selected, may be

renominated as rising seniors.

4. All students must meet the aptitude/achievement criteria as established

by the Board of Governors for North Carolina Governors School.

a. Most recent aptitude test scores: composite or subtest scores

documenting percentile ranges from 92% through 99%.

b. Achievement test scores: composite, subtest, or End-of-Coursescores in appropriate area of nomination shall be used documenting

percentile ranges from 92% through 99%. Scores other than EOCs

must 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: National percentile scores must be used for all aptitude and

achievement tests with the exception of EOC tests (state

percentile scores).

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 students area of nomination may be used for

students nominated in Math, English, Natural Science, or Social

Science. 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 GovernorsSchool nominees.

Scholastic performance: most recent grade in area of nomination

(if applicable), class rank (if available), and the most recent transcrip

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 Governors School Student Application, with

all attachments, and submits it to school personnel.

2. SCHOOL PERSONNEL

High School Staff (often in coordination with the local Governor

School Contact Person):

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

headmaster.

b. Assembles a complete application(Application Form,essays, Experience Form, Eligibility and Selection Criteria

Form, transcript, and Recommendation Forms removed

from envelopes) on each nominee and submits it to the high

school principal/school director/headmaster.

High School Principal/School Director/Headmaster (often in

coordination with the local Governors School Contact Person):

a. Verifies and signs the Eligibility and Selection Criteria Form

on each nominee.

b. Recommends (often through a school-based committee) and

submits complete applications of the outstanding nominees

to the Superintendent, when applicable.

Superintendent/Director/Headmaster (often involving the local

Governors School Contact Person):

a. Consults the Nomination Chartto determine the total numbeof nominees allowed. See the following exceptions.

(1) French These nominations are unlimitedand do not

count against the number of academic nominations.

However, the number of students selected in French is

quite small. Consider nominating only those students

who are very strong in French and can speak it fluently.

(2) Instrumental Music and Choral Music Nominations

for 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 unlimitedand will not count against

the number of performing/visual arts nominations.


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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 to

36 inches in width and height. Framed artwork will not be accepted;

matting is allowed. Space is limited; therefore, no easels or props are

permitted. During the judging, nominees must stand by their artwork

to answer questions about their work. Informal questions may be

asked to help the nominee feel at ease. Any other questions asked

will be related to the students artwork. Nominees must stay until

dismissed by the judges.

Dance

All nominees will audition together in a modern dance class; therefore,a prepared routine is not necessary. Dance nominees should wear

practice clothing only (leotards and tights for females; dance or yoga

pants and t-shirt or tank for males). All clothes should be form fitting.

Ballet shoes are not to be worn; nominees will be auditioning in their

bare 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 be

performance related. Nominees must stay until dismissed by the judges.

Theater

You 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. Select

material which is best suited to your particular ability and demonstrates

your range. (The judges will be interested in seeing more than a one-

dimensional monologue.) If you are portraying a character, choose

someone close to your own age and gender. No costumes or props

are necessary. You will be auditioning in a classroom not on a stage.

Students who also have an interest in theater tech should bring a

resum or portfolio of lighting or set design/building achievements to

share with the judges. Informal questions may be asked to help you feel

at ease. Any other questions asked will be performance related.

Choral Music

Choral music nominees should be prepared to sing a piece of their own

choosing not to exceed two minutes. Nominees should consult with

their music teacher for a piece suitable for their voice. Nominees must

bring two originals of their selection to auditions. One original will

be used by the nominee and the second original will be used by the

judge. Photocopies will not be allowed under any circumstance due to

copyright laws. Nominees arriving for auditions with only one original

of their selection must be prepared to sing their selection by memory.

NO EXCEPTIONS CAN BE MADE.All nominees will be asked to sight-read

a 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 their

children. 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.) Informal

questions may be asked to help the nominee feel at ease. Any other

questions asked will be performance related.

Instrumental Music

Instrumental music nominees should be prepared to play a piece of their

own 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 their

selection to auditions. One original will be used by the nominee and the

second original will be used by the judge. Photocopies will not be allowed

under any circumstance due to copyright laws. Nominees arriving for

auditions with only one original of their selection must be prepared to play

their selection by memory. NO EXCEPTIONS CAN BE MADE. All nominees

will be asked to sight-read a selection chosen by the judge. No scales are

required. Nominees must bring their own instrument except those nominees

auditioning on the mallet percussion and timpani. Instrumentalists are

expected to perform unaccompanied. The following instruments will be

auditioned: Flute/Piccolo, Oboe/English Horn, Clarinet (E-flat, B-flat, 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 auditioned.

Informal questions may be asked to help the nominee feel at ease. Any othe

questions 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 Governors School. The superintendent is to indicate the one Superintendent Choice by

placing the students name by the * below. The Superintendent Choice cannot be a French or Spanish nominee. The remaining nominations in academics 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.

* Automatically invited to attend.

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

name gender/race nomination area

*

UNLIMITED ACADEMICS (Rising Seniors Only)

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


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 Form

PAGE 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)

flute/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), percussion

instruments, or string instruments (violin, viola, cello, bass, and harp)




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Charter/Non-Public/Special SchoolNomination Form

CONTINUED

Please list below all students from your school nominated for the Governors 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)

flute/piccolo, clarinet, and saxophone only


THEATER (Rising Seniors Only)

name gender/race

UNLIMITED CHORAL MUSIC (Rising Juniors or Seniors)alto, tenor, and bass/baritone voices



UNLIMITED INSTRUMENTAL MUSIC (Rising Juniors or Seniors)

double-reed instruments (oboe and bassoon), brass instruments

(trumpet, French horn, trombone, euphonium, and tuba), percussion

instruments, or string instruments (violin, viola, cello, bass, and harp)




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Student Application

STAPLE NO PAPER CLIPS PAGE 1 OF 2FORM 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 specific area)

___ English

___ Mathematics

___ Natural Science

___ Social Science

___ Spanish

___ French

Performing/Visual Arts(Check one specific 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 Governors School nominee. I understand that I will be identifiedas a Governors School nominee only if determined by the local nominating committee. I understand that if I am selectedby the State, and if I accept, I will attend the entire five-week program. I further understand that no exceptions will bemade for family reunions, cheerleading camps, sports activities, and the like.

____________________________________________________ ____________________________________________________Signature of Student Date Signature of Parent/Guardian Date

Notes Students in Mathematics must have completedAlgebra II or Integrated Math III before the2013 session begins.

Students in Spanish and French must have completed

at least two years of study in these courses beforethe 2013 session begins.

Academics Performing/Visual Arts

Notes Instruments offered are: Flute/Piccolo, Oboe/English

Horn, 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.

Piano and guitar are not offered.


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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 and discuss one signicant problem or issue in contemporary culture that concerns you: some of the dimensions

of 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 applicants interest inthe Area I field of nomination. If you know your Area I field of nomination, choose the topic for that discipline. If you donot yet know your Area I field 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 influenced 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 influenced your thoughts and/or action.

Nominees in Mathematics:Describe your response to the following quote: The true spirit of delightis 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 specifically 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 Formand 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 nominees strengths in thearea of nomination and can address the nominees intellectual curiosity, love of learning, and potential to profit from the

Governors 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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Awards and Honors during the past three years.

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PAGE 1 OF 2

FORM MAY BE COPIED

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 2

FORM MAY BE COPIED

Experience Form


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Recommendation Form

Students Name____________________________________ Nomination Area ___________________

School_______________________________School System_________________________________

Subjects you have taught this nominee if you are a teacher: ______________________________________(preferably in the students area of nomination)

9thgrade___________________ 10thgrade____________________ 11thgrade____________________

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 students 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 ideas and challenging material

Ability to synthesize ideas

Ability 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 SCHOOL

TEACHER, 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 students stability, character, maturity, and attitude towards peers, teachers, and others?To what degree does the student demonstrate:

11.

2.

3.

4.

15.

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

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


C. Are you confident that this student:

is inquisitive, serious, and exible enough to entertain speculative questions YES NOand to push intellectual boundaries?

can independently function at a high level for ve weeks away from home YES NOin a challenging academic and residential environment?


____________________________________________________ ____________________________________________________Signature Date Title

The information provided is confidential and will be read only by persons responsible for student selection and faculty and staff of the Governors Schoo

Recommendation Form

PAGE 2 OF 2


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Eligibility and Selection Criteria Form

FORM MAY BE COPIED

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 national percentile score: 92, 93, 94, 95, 96, 97, 98 or 99

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

1. Indicate Achievement Test name: __________________________________________________________________________________

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

or End-of-Course Test (see Acceptable EOC Testsbelow) (specify) _______________________________

3. Write year test was given: _____________________________

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

(Use state percentile score for EOC tests.)

ACCEPTABLE EOC TESTS: English English I

Mathematics Algebra I, Algebra II, & Geometry

Natural Science Biology, Physical Science, Chemistry, & Physics

Social Science Civics and Economics & US History. If scores are not available, English I EOC test score is allowed.

Any EOC test may be used for students nominated in French, Spanish, or the Performing/Visual Arts.

EOC test scores must be 92 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 9th, 10th, or 11thgrade. Scores from EOC tests taken in the 6th, 7th, and 8thgrades will be accepted.

* End of Grade test scores will not be accepted.

Scholastic Performance Criteria1. 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 scores below92 percentile will not be considered for selection.

NOTE: Applications with achievement scores below92 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)

Ravens Progressive Matrices

Reynolds Intellectual Assessment Scales (RIAS)

Scholastic Abilities Test for Adults, Aptitude

Portion (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 the

WISC III are administrations before 2005. Any use

of 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 are

administrations before 2010. Any use of the WAIS III

after 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 II (KTEA 2)

Metropolitan Achievement Test 8

PLAN (Preliminary ACT Assessment)

Preliminary Scholastic Assessment Test (PSAT)

Scholastic Abilities Test for Adults, Achievement

Portion (SATA)

Scholastic Assessment Test (SAT)

Stanford Achievement Test 10

TerraNova

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 Divisionof the NC Department of Public Instruction must be contacted for approval of any testsnot listed here.

National percentile scores must be used for all aptitude and achievement tests with

the exception of EOC tests (state percentile scores).


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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 number

Superintendent Choices (public school systems & federal schools only)

race and gender

nominated students coincide with Nomination Chart

2. APPLICATION FORM (FOR EACH NOMINEE)

signatures (statement of intent)

identifying information

school unit and high school

nomination choice

two 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 scores

approved 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

Each application stapled (no paperclips) and presented in the following order:

1. Application Form2. typed essays

3. Experience Form4. 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 14, 2012.

Mail to: Camilla Roberson, Special Assistant for Governors SchoolExceptional Children Division | NC Department of Public Instruction6356 Mail Service Center | Raleigh, NC 27699-6356

DO NOT SEND THIS CHECKLIST WITH APPLICATIONS.


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