millennium high school application checklist...millennium high school application checklist mi l l e...

Millennium High School Application Checklist

Millennium High School will start reviewing applications for the 2018-2019 school year on February 16, 2018. For application submitted by February 16th, candidates selected for an interview you will be contacted by March 2nd. Please return complete application and recommendations document to:

Millennium High School Interdistrict Transfers 760 Magnolia Ave.

Piedmont, CA 94611

To insure that your application is reviewed promptly please use the following checklist. Only complete applications can be reviewed. ❏ PUSD Student Enrollment Form

❏ PUSD Application

❏ English Teacher Recommendation Form (to be completed by your student’s current English teacher)

❏ Math Teacher Recommendation Form (to be completed by your student’s current Math teacher)

❏ Counselor/Principal Recommendation Form (to be completed by your student’s current

Counselor/Principal)

❏ MHS Expectation and Acknowledgements page

❏ Current transcript

❏ A copy of your student’s birth certificate

❏ Current immunization record with proof of current Tdap vaccination

❏ A copy of applicant’s most recent IEP, 504 Plan, General Education Plan, etc. (if applicable )

Please note: All of the above documents are necessary to evaluate Millennium High School’s capacity to serve your student. Failure to provide any of the above documents in your initial may result in the rescinding of any offer of placement at MHS.

!

Piedmont)Unified)School)District)STUDENT)ENROLLMENT)FORM)

! Student’s LEGAL Name: (from birth certificate) Birth Date: ___/___/______ Gender: ! Male ! Female

_______________________________________________________________________________________ __________ Last First Middle Suffix

ETHNICITY ! Hispanic/Latino (A person of Spanish culture or origin, regardless of race) ! Not Hispanic or Latino

RACE Please check up to five racial categories. No matter what you selected above, please continue to answer the following by marking one or more boxes to indicate what you consider your child’s race to be.

! American Indian / Alaskan Native (100) ! Laotian (206) ! Tahitian (304) (Original peoples of North, Central or South America) ! Cambodian (207) ! Other Pacific Islander (399)

! Chinese (201) ! Hmong (208) ! Filipino/Filipino American (400) ! Japanese (202) ! Other Asian (299) ! Black (600) ! Korean (203) ! Hawaiian (301) ! White (700) ! Vietnamese (204) ! Guamanian (302) (Original peoples of Europe, North Africa, ! Asian Indian (205) ! Samoan (303) or the Middle East) Nickname/goes by: ________________________ My child currently receives services under ! 504 plan ! IEP

OTHER CHILDREN IN THE FAMILY

Name Relationship Birthdate Lives at home? School Grade ___________________________________ ________________ ___/___/______ ! Yes ! No ___________________________________ _____

___________________________________ ________________ ___/___/______ ! Yes ! No ___________________________________ _____

___________________________________ ________________ ___/___/______ ! Yes ! No ___________________________________ _____

___________________________________ ________________ ___/___/______ ! Yes ! No ___________________________________ _____

Student resides with:

_____________________________________________________(______)_____________________(______)___________________ Parent/Guardian Last Name First Name Work Phone Cell Phone

___________________________________________________________________________________________________________ Relationship to Student Occupation Email

_____________________________________________________(______)_____________________(______)___________________ Parent/Guardian Last Name First Name Work Phone Cell Phone


!Address: ___________________________________________________________________________________________________ City Zip Home Phone (_______)________________________ Grade: ______ Last school attended: _______________________________________________________________________________ Name of School Address / City / State / Zip Grade(s) Last Day of Attendance

Has your child ever been enrolled in a California school? ! Yes ! No … if Yes, please indicate the city:

Did your child attend preschool in the U.S.? ! Yes ! No … if Yes, please indicate # of years:

Rev.%2'4'15%

–!OFFICIAL!USE!ONLY!–!

Today’s!Date:!___________!

Grade:! ___________!

–!OFFICIAL!USE!ONLY!–!Immunizations:!!__________________!TB:!!_____!

Initials:!_________!!Date:__________!!

!

!

_______________________________________________________________________________________ __________ Last First Middle Suffix

HOME LANGUAGE SURVEY:

1. Which language did your child learn when he/she first began to talk? ___________________________

2. Which language does your child most frequently speak at home? ___________________________

3. Which language do you (the parents or guardians) most frequently use when speaking with your child? ___________________________

4. Which language is most often spoken by adults in the home? (parents, guardians, grandparents, or any other adults) ___________________________

Has your child ever been given the California English Language Development Test (CELDT)? ! Yes ! No ! I don’t know Date of Birth: _____/_____/_____ Month Day Year Birth Country: _____________________________________________

Birth Verification ! Birth certificate ! Passport Birth State: _____________________________________________

Birth City: _____________________________________________

If not born in the US: First entered the US ___/___/___ First attended school in the US ___/___/___ First attended school in California ___/___/___ Month/Day/Year Month/Day/Year Month/Day/Year

PARENT EDUCATION LEVEL – Check the response that describes the highest education level of parent/guardian(s): ! Graduate school/post graduate training ! Some college (includes AA degree) ! Not a high school graduate ! College graduate ! High school graduate

Secondary Residence: (if applicable)

Address: __________________________________________________________________________________________________ City State Zip

________________________________________(_____)_________________(_____)_________________(_____)______________ Parent/Guardian Last Name First Name Home Phone Work Phone Cell Phone


________________________________________(_____)_________________(_____)_________________(_____)______________ Parent/Guardian Last Name First Name Home Phone Work Phone Cell Phone

___________________________________________________________________________________________________________ Relationship to Student Occupation Email If there is a legal custody agreement regarding this student, please check one: ! Joint Custody ! Sole Custody ! Guardian Send duplicate mailings to Secondary Residence? ! Yes ! No

!FOR KINDERGARTEN STUDENTS ONLY: Placement Request: ! Morning (8:30 a.m. – 11:45 a.m.) ! Afternoon (11:45 a.m. – 3:10 p.m.) ! No preference

Information to consider: ________________________________________________________________________________________ FOR HIGH SCHOOL STUDENTS ONLY: Student Cell (_______)_________________________ Student Email _______________________________________________ !

I (We) declare, under penalty of perjury, that I am (we are) the parent(s) or court-appointed legal guardian(s) of the above named student and that he/she lives with me (us) at the Piedmont address noted above.

Date:_________________________ Signature of Parent/Guardian:_____________________________________________________________

Date:_________________________ Signature of Parent/Guardian:_____________________________________________________________

RESIDENCY VERIFICATION: ! Grant Deed ! Property Tax Statement ! Rental/Lease Contract ! Property Owner’s Business Tax License ! Tax return ! W-2 ! Bank statement ! PG&E/EBMUD ! Major credit card ! Other ______________________________________ Completed by: ___________________________________ Date: ________________

For!!Chinese,!please!designate!

Cantonese!or!

Mandarin!

Rev.%2/4/15%

!

Rev 1/2013

Applicant 20______ ☐9th ☐10th ☐11th ☐12th

Name First Middle Last preferred name/nickname

Birth Date Age ☐M ☐F

Family Information Parent/Guardian 1 Parent/Guardian 2

Address Address

City State ZIP City State ZIP

Home Phone Home Phone

Cell Phone Cell Phone

Email Email

Occupation Occupation

Employer Employer

Work Phone Work Phone

With whom does the applicant live?

☐Both parents ☐Part time with both (explain) ☐Other (explain)

Details

Educational Background Current School School Reference

Address Title/Position

City State ZIP Phone

List the classes in which you are currently enrolled:

English Math

Science Foreign Language

History Other

Please list all schools attended since 7th grade (School/City/Grade(s)/Dates)

Rev 1/2013

Questions: To be filled out by student applicant If you are transferring from another high school, what are your reasons for leaving? __________________________________________________________________________________________________________________________________________________________ Describe any special circumstances which may have interfered with your ability to do your best work? __________________________________________________________________________________________________________________________________________________________ Describe any health problems or physical limitations that could affect your school participation. __________________________________________________________________________________________________________________________________________________________ What activities are you involved in outside of school? __________________________________________________________________________________________________________________________________________________________ What kinds of things interest you? __________________________________________________________________________________________________________________________________________________________ Why are you interested in Millennium High School? __________________________________________________________________________________________________________________________________________________________ Special Education or General Education Support: To be filled out by Parent or Guardian If applicable, please check what services your student receives and provide a copy of the appropriate plan ☐IEP ☐504 Plan ☐General Education Plan ☐SST Plan Briefly describe your student’s learning disabilities or challenges (if applicable): __________________________________________________________________________________________________________________________________________________________ To Complete the Application Return the signed application with the following attachments. We realize that some schools do not send out information until mid-January. ☐Most current report cards or transcript(s):

9th Grade applicants – transcripts for 7th & 8th grade 10th-12thGrade applicants – transcripts for all grades completed in high school

☐Math teacher recommendation ☐English teacher recommendation ☐Principal/Counselor recommendation ☐If applicable: ☐IEP ☐504 Plan ☐General Education Plan ☐SST Plan ☐Birth certificate and immunization record with Tdap verification I authorize Millennium High School to contact the references listed above in order to discuss the applicant’s standing in school. Student Signature: Date: Parent/Guardian Signature: Date:

Rev 1/2013

Current Mathematics Teacher Recommendation Form To the Applicant: Please type or print your name and give this form to your current Mathematics teacher with a stamped envelope addressed to Millennium High School. Applicant name: Applying for Grade: To the Parent/Guardian: Please read and sign the statement below. For the student named above, I authorize the release of school records, including an official transcript of all grades for the past two years as well as academic testing results. I acknowledge that I waive my right to read the confidential teacher recommendations and the school report. Signature of Applicant’s Parent or Guardian: Date: To the Teacher: This recommendation will remain confidential and will not become part of the student’s permanent record. Please be sure the parent has signed above. We sincerely appreciate your cooperation and candor. Compared to other students in his or her class year, how do you rate the student in terms of:

Academic Qualities NO OPPORTUNITY TO OBSERVE POOR

BELOW AVERAGE AVERAGE GOOD EXCELLENT

ONE OF THE BEST EVER

Study habits Attention span Ability to work independently Ability to organize and

communicate ideas

Motivation Intellectual curiosity Critical and abstract thinking

skills

Personal Qualities NO OPPORTUNITY TO OBSERVE POOR



Creativity Self-confidence Leadership potential Reaction to criticism Reaction to setbacks Concern for others Personal conduct Personal integrity Ability to act independently Ability to work cooperatively General level of maturity Sense of humor

Rev 1/2013

1. This student is enrolled in: ☐Arithmetic ☐Pre-algebra ☐ Algebra ☐ Geometry ☐ Other: Section level of course: ☐Remedial ☐ Regular ☐ Advanced ☐ Mixed-Ability

2. Please compare this student’s academic achievement to his/her ability. ________________________________________________________________________________________________________________________________________________

3. Please describe the student in Math. (Compare ability to retain mathematical relationships and principles, drawing generalizations, applying basic principles in word problems, and relying on memory versus conceptual processes.) ________________________________________________________________________________________________________________________________________________

4. Have absences in any way affected the student’s classroom performance? ________________________________________________________________________________________________________________________________________________

5. Comment on the student as a person. (Consider maturity, integrity, behavior, and relationships with peers, self-confidence.) ________________________________________________________________________________________________________________________________________________

6. Is there any additional information that can be better conveyed in a phone call? ☐Yes ☐ No ☐If Necessary

a. Hours and phone number where you can be reached: b. Grade(s) you have taught this applicant: ☐7th ☐ 8th ☐ 9th ☐ 10th ☐ 11th ☐ 12th

Name Position

School Name School Phone

Email

Signature Date I recommend this student not at all with reservation mildly with confidence enthusiastically

Academic ability and promise Character and promise Overall Please make any additional comments: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Rev 1/2013

Current English Teacher Recommendation Form To the Applicant: Please type or print your name and give this form to your current English teacher with a stamped envelope addressed to Millennium High School. Applicant name: Applying for Grade: To the Parent/Guardian: Please read and sign the statement below. For the student named above, I authorize the release of school records, including an official transcript of all grades for the past two years as well as academic testing results. I acknowledge that I waive my right to read the confidential teacher recommendations and the school report. Signature of Applicant’s Parent or Guardian: Date: To the Teacher: This recommendation will remain confidential and will not become part of the student’s permanent record. Please be sure the parent has signed above. We sincerely appreciate your cooperation and candor. Compared to other students in his or her class year, how do you rate the student in terms of:





communicate ideas


skills





Rev 1/2013

1. Please compare this student’s academic achievement to his/her ability.

________________________________________________________________________________________________________________________________________________

2. Comment on this student’s reading and writing skills. ________________________________________________________________________________________________________________________________________________

3. In this student’s academic work, does he or she require prodding or additional supervision? Please elaborate. ________________________________________________________________________________________________________________________________________________

4. Have absences in any way affected the student’s classroom performance? ________________________________________________________________________________________________________________________________________________



a. Hours and phone number where you can be reached: b. Grade(s) you have taught this applicant: ☐7th ☐ 8th ☐ 9th ☐ 10th ☐ 11th ☐ 12th

Name Position


Email


Academic ability and promise Character and promise Overall Please make any additional comments: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Rev 1/2013

Current Principal/Counselor Recommendation Form

To the Applicant: Please type or print your name and give this form to your current Principal/Counselor with a stamped envelope addressed to Millennium High School. Applicant name: Applying for Grade: To the Parent/Guardian: Please read and sign the statement below. For the student named above, I authorize the release of school records, including an official transcript of all grades for the past two years as well as academic testing results. I acknowledge that I waive my right to read the confidential teacher recommendations and the school report. Signature of Applicant’s Parent or Guardian: Date: To the Principal/Counselor: This recommendation will remain confidential and will not become part of the student’s permanent record. Please be sure the parent has signed above. We sincerely appreciate your cooperation and candor. Compared to other students in his or her class year, how do you rate the student in terms of:





communicate ideas


skills





Rev 1/2013

1. For how long and in what context have you known this student? ________________________________________________________________________________________________________________________________________________

2. Please comment on this applicant’s special interests, talents, and abilities. ________________________________________________________________________________________________________________________________________________

3. Should the admission committee be made aware of any factors or disciplinary action that has had an impact on this student’s academic or social progress to date? ________________________________________________________________________________________________________________________________________________



a. Hours and phone number where you can be reached:

Name Position


Email


Academic ability and promise Character and promise Overall Please make any additional comments: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If accepted into Millennium High School Student please initial acknowledging the following: Participation:

____ I will participate in school organizations ____ I will participate in community projects ____ I will participate in class

Attendance: ____ I will attend grade level advisories once a month ____ I will attend tutorial regularly when I need help ____ I will attend tutorial when assigned to tutorial ____ I understand I will be assigned detention if I have 3 or more tardies in a

week Academic Probation:

____ I must earn 1.5 in credits in each class each marking period ____ I must earn 5 credits in each class each semester ____ I must maintain “S” (satisfactory) marks in each class on each progress

report ____ I must maintain a positive attitude/positive behavior

Student please sign below: Student signature:___________________________________ Date:_____________ Parent(s)/Guardian(s) Parent(s)/Guardian(s) will participate in the Millennium High School community by attending Parent Club meetings, Back to School Night, show cases, Millennium Community Dinner/Fundraisers as regularly as possible. Parent(s)/Guardian(s) will partner with teachers and school administrators to help your student succeed in their education at Millennium High School. Please sign below acknowledging the above. Parent/Guardian Signature ______________________________ Date:_____________

millennium high school application checklist...millennium high school application checklist mi l l e...

Documents