page 1 of 8 part 1a. for office use only general

FOR OFFICE USE ONLY

A4L ____ C4L ____ HPAP ____

CENTRAL ____ EAST ____ NORTH ____ WEST ____ EXT.____

GENERAL INFORMATION

STUDENT INFORMATION

FIRST NAME: LAST NAME:LAST NAME:

DATE OF BIRTH (MONTH / DAY / YEAR): _______ / _______ / ___________DATE OF BIRTH (MONTH / DAY / YEAR): _______ / _______ / ___________ MALE: ____ FEMALE: ____

STREET ADDRESS: STREET ADDRESS: STREET ADDRESS:

TOWN / CITY: POSTAL CODE: POSTAL CODE:

HOME PHONE: CELL PHONE:CELL PHONE:

EMAIL ADDRESS:EMAIL ADDRESS:EMAIL ADDRESS:

PARENT INFORMATION

1st PARENT / GUARDIAN: 2nd PARENT / GUARDIAN:

ADDRESS:

SAME AS ABOVE ___

ADDRESS:

SAME AS ABOVE ___

HOME PHONE: HOME PHONE:

BUS. PHONE: BUS. PHONE:

CELL PHONE: CELL PHONE:

EMAIL: EMAIL:

EDUCATION

CURRENT SCHOOL:CURRENT SCHOOL: SCHOOL BOARD:

ADDRESS:ADDRESS:ADDRESS:

TOWN / CITY:TOWN / CITY: POSTAL CODE:

CURRENT GRADE: NAME OF HOMEROOM TEACHER:NAME OF HOMEROOM TEACHER:

HOME HIGH SCHOOL:HOME HIGH SCHOOL:HOME HIGH SCHOOL:

SCHOOL BOARD FOR HOME HIGH SCHOOL:SCHOOL BOARD FOR HOME HIGH SCHOOL:SCHOOL BOARD FOR HOME HIGH SCHOOL:

ACADEMIC SERVICES -- (IEPʼs must be attached)

SPECIAL EDUCATION: YES__ NO__ IEP: YES__ NO__ IPRC DATE: ______________________

STUDENT IS CURRENTLY BEING TESTED FOR SPECIAL ACADEMIC SERVICES: YES ___ NO ____STUDENT IS CURRENTLY BEING TESTED FOR SPECIAL ACADEMIC SERVICES: YES ___ NO ____STUDENT IS CURRENTLY BEING TESTED FOR SPECIAL ACADEMIC SERVICES: YES ___ NO ____

SPECIAL EDUCATION TEACHER (IF APPLICABLE):SPECIAL EDUCATION TEACHER (IF APPLICABLE):SPECIAL EDUCATION TEACHER (IF APPLICABLE):

ENGLISH LANGUAGE LEARNER: ESL__ ELD__ LEVEL:

ADDITIONAL SUPPORT: YES__ NO__ EXPLAIN:

CURRENT FRENCH PROGRAM: FRENCH SCHOOL____ IMMERSION____ EXTENDED____

PART 1A.

Bill Crothers Secondary School | 44 Main Street | Unionville, ON | L3R 2E4

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STUDENT SPORT INFORMATION

PLEASE SELECT THE PROFILE THAT BEST REFLECTS YOUR PARTICIPATION IN SPORT

Active for Life Student Profile _____Student athletes in the Active for Life profile are involved in sport in a variety of ways including: recreational competition, officiating, coaching, volunteering and media interests.

Competitive for Life Student Profile _____Student athletes in the Competitive for Life profile are committed to serious training and competition with goals of reaching the next level in sport. These athletes may be on the path to high-performance status.

High Performance Athlete Profile ____The High Performance Athlete profile describes a student athlete who is highly-ranked, or has been selected for a provincial, national, or international team or development team (e.g. Team Ontario or Team Canada). Please note that for this profile, the supplemental HPAP application must be completed.

Para-Athletes ____BCSS welcomes and encourages applications from athletes with permanent locomotor disabilities.

PRIMARY SPORT (COMPLETE ALL SECTIONS THAT APPLY):

SPORT: YEAR / SEASON:YEAR / SEASON:

TEAM / CLUB:TEAM / CLUB:TEAM / CLUB:

LEAGUE / LEVEL:LEAGUE / LEVEL: TRAINING HRS / WEEK: __________

RANKINGS (APPLIES TO INDIVIDUAL SPORTS ONLY)RANKINGS (APPLIES TO INDIVIDUAL SPORTS ONLY)RANKINGS (APPLIES TO INDIVIDUAL SPORTS ONLY)

1st EVENT:1st EVENT:1st EVENT:

2nd EVENT:2nd EVENT:2nd EVENT:

SECONDARY SPORT (COMPLETE ALL SECTIONS THAT APPLY):

SPORT: YEAR / SEASON:YEAR / SEASON:

TEAM / CLUB:TEAM / CLUB:TEAM / CLUB:

LEAGUE / LEVEL:LEAGUE / LEVEL: TRAINING HRS / WEEK: __________

RANKINGS (APPLIES TO INDIVIDUAL SPORTS ONLY)RANKINGS (APPLIES TO INDIVIDUAL SPORTS ONLY)RANKINGS (APPLIES TO INDIVIDUAL SPORTS ONLY)

1st EVENT:1st EVENT:1st EVENT:

2nd EVENT:2nd EVENT:2nd EVENT:

ADDITIONAL SPORT ACTIVITY (CAN INCLUDE RECREATIONAL COMPETITION, OFFICIATING, VOLUNTEERING, AND COACHING).

SPORT / ACTIVITY YOUR INVOLVEMENT YEAR / SEASON CLUB / SCHOOL NAME

PART 1B.


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STUDENT AND PARENT/GUARDIAN RESPONSES

STUDENT QUESTIONNAIRE -- PLEASE LIMIT RESPONSE TO 100 WORDS & TYPE IF POSSIBLE

Explain why health and physical education is important. In your response, relate this to your personal experience. Please submit on a separate piece of paper.

STATEMENT FROM PARENT/GUARDIAN -- PLEASE LIMIT RESPONSE TO 100 WORDS & TYPE IF POSSIBLE

Explain how attending BCSS will support your child. Please make us aware of any exceptional circumstances (academic, social, family, etc.).Please submit on a separate piece of paper.

STUDENT & PARENT/GUARDIAN DECLARATION

I hereby certify that all of the information submitted in this application is accurate. ☐

I understand that students should only take vacations during school holidays in the BCSS calendar. ☐

If any information in this application is found to be false or inaccurate, I understand it may result in the application not being considered. ☐

STUDENT SIGNATURE: DATE:

PARENT/GUARDIAN SIGNATURE: DATE:

HOW DID YOU HEAR ABOUT BCSS?

School Coach ____ Flyer / Letter ____ Teacher ____

Club Coach ____ Newspaper ____ Sibling ____

School Newsletter ____ Regional Directory ____ Website ____

Other (Please specify): Other (Please specify): Other (Please specify):

Did you attend a BCSS information night? YES ____ NO ____

STUDENTS CURRENTLY IN GRADE 9, 10, 11, OR 12

If accepted, are you interested in starting in the second semester of THIS academic year? YES ____ NO ____If accepted, are you interested in starting in the second semester of THIS academic year? YES ____ NO ____

Please note that OFSAA transfer rules will impact student eligibility to play at BCSS. Please refer to the YRAA website: www.yraa.comPlease note that OFSAA transfer rules will impact student eligibility to play at BCSS. Please refer to the YRAA website: www.yraa.com

Please identify current high school sports that you compete in using the spaces provided below:Please identify current high school sports that you compete in using the spaces provided below:

PART 1C.


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http://www.YRAA.com

http://www.YRAA.com

TEACHER REFERENCE FORM -- ONLY 1 TEACHER REFERENCE IS REQUIRED

INSTRUCTIONS FOR STUDENT APPLICANTS

Print this form and give it to your teacher. You may wish to print the BCSS brochure to give to your teacher. This teacher must be a different person from the individual who completed the coaching reference and must have taught the student applicant in a core subject within the last twelve months.

INSTRUCTIONS FOR TEACHERS

Fill out the form below and place it in an envelope addressed to Bill Crothers S.S. Admissions Committee. Seal the envelope and sign over the seal. You may send via the student applicant, board courier, or regular mail. This information is confidential and only shared with the assessment committee.Thank you for the time and consideration you have given to this student-athlete.

STUDENT NAME: SCHOOL NAME:

TEACHER NAME:

TEACHER EMAIL:

SUBJECT(S) TAUGHT TO STUDENT APPLICANT:

How many years have you known this student? ____ How long have you taught this student? ___________

Would you recommend this student for Student Success support? YES ____ NO ____Would you recommend this student for Student Success support? YES ____ NO ____

SPECIAL EDUCATION SUPPORT (IF APPLICABLE):

IEP ____ Non-Identified IEP ____ Testing in progress ____

Is this student receiving instruction in all subjects at grade level? YES ____ NO ____Is this student receiving instruction in all subjects at grade level? YES ____ NO ____Is this student receiving instruction in all subjects at grade level? YES ____ NO ____

If no, explain:If no, explain:If no, explain:

ENGLISH LANGUAGE SUPPORT (IF APPLICABLE):

ESL: YES ____ NO ____ LEVEL: ____ ELD: YES ____ NO ____ LEVEL: ____

Rate the student according to the following criteria. Provide an appropriate evaluation for each of the areas listed below between 0 and 10 [0 = Low, 10 = High]

Accepts responsibility Demonstrates appropriate behaviour

Follows directions Works independently when required

Uses class time constructively Seeks help when appropriate

Follows class and school rules Participates in co-curricular activities

Respects self, others, and school environment Demonstrates interpersonal skills

Overall Recommendation: Poor Fair Good Excellent Outstanding

Additional Comments:

TEACHER SIGNATURE: DATE:

PART 2A.


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COACH REFERENCE FORM -- ONLY ONE COACHING REFERENCE IS REQUIRED

INSTRUCTIONS FOR STUDENT APPLICANTS

Print this form and give it to your coach. You may wish to print the BCSS brochure to give to your coach. This coach must be a different person from the individual who completed the teacher reference and cannot be the parent of the applicant.

INSTRUCTIONS FOR COACHES

Fill out the form below and place it in an envelope addressed to Bill Crothers S.S. Admissions Committee. Seal the envelope and sign over the seal. You may send via the student applicant, board courier, or regular mail. This information is confidential and only shared with the assessment committee.Thank you for the time and consideration you have given to this student-athlete.

ATHLETE NAME:

COACH NAME:COACH NAME:

COACH EMAIL:COACH EMAIL:

SPORT: LEVEL:

CLUB OR SCHOOL NAME:CLUB OR SCHOOL NAME:

How long have you known the athlete? ____________ How long have you coached the athlete? ___________

Rate the student according to the following criteria. Provide an appropriate evaluation for each of the areas listed below between 0 and 10 [0 = Low, 10 = High]

Accepts challenges Punctuality / Attendance

Takes initiative Respect for coaches and officials

Team player Effort

Positive attitude Coachable

Leadership Commitment to fitness

Overall Recommendation: Poor Fair Good Excellent Outstanding

Additional Comments:

COACH SIGNATURE: DATE:

PART 2B.


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SUPPLEMENTARY APPLICATION -- HIGH PERFORMANCE ATHLETE PROFILE (HPAP) SPORT INFORMATION

In order to qualify under the High Performance Athlete Profile, a student must meet at least one of the following criteria:

1) He or she has been selected for a provincial, national, or international team or development team. (e.g. Team Ontario or Team Canada)

2) He or she has been identified and/or highly-ranked provincially or nationally by a provincial or national sport organization and governing body (e.g. Swimming Canada or Swim Ontario).

3) He or she has a high-volume training schedule with off-site training sessions that occur during school hours.

ATHLETE NAME:ATHLETE NAME:

SPORT:SPORT:

COACH NAME:COACH NAME:

COACH EMAIL: COACH PHONE:

TRAINING CENTRE:TRAINING CENTRE:

SPORT GOVERNING ORGANIZATION:SPORT GOVERNING ORGANIZATION:

CONTACT NAME FROM GOVERNING ORGANIZATION:CONTACT NAME FROM GOVERNING ORGANIZATION:

ATHLETE STATUS:

Have you attended a training camp / development program delivered by a Provincial or National Sport Organization? YES ____ NO ____ If you answered YES, please provide information below.Have you attended a training camp / development program delivered by a Provincial or National Sport Organization? YES ____ NO ____ If you answered YES, please provide information below.

NAME OF PROGRAM: DATE(S) ATTENDED:

Have you been selected to Team Canada or a national team program for your sport? YES ____ NO ____ If you answered YES, please provide information below:Have you been selected to Team Canada or a national team program for your sport? YES ____ NO ____ If you answered YES, please provide information below:

TEAM NAME & AGE GROUP: YEAR OF SELECTION:

Have you been selected to Team Ontario or a Provincial Team program in your sport? YES ____ NO ____ If you answered YES, please provide information below.Have you been selected to Team Ontario or a Provincial Team program in your sport? YES ____ NO ____ If you answered YES, please provide information below.

TEAM NAME & AGE GROUP: YEAR OF SELECTION:

If your sport uses a provincial and/or national ranking system, and you are a ranked athlete, provide your provincial and/or national ranking below, along with any details. (e.g. 10th - 100m Backstroke)If your sport uses a provincial and/or national ranking system, and you are a ranked athlete, provide your provincial and/or national ranking below, along with any details. (e.g. 10th - 100m Backstroke)If your sport uses a provincial and/or national ranking system, and you are a ranked athlete, provide your provincial and/or national ranking below, along with any details. (e.g. 10th - 100m Backstroke)

RANK: PROVINCIAL ___ NATIONAL ____ SPORT / EVENT:



CONFIRMATION OF ATHLETIC STATUS / RANKING:

Provide a website URL for the organization that can verify your ranking:

PART 3A.


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SUPPLEMENTARY APPLICATION -- HIGH PERFORMANCE ATHLETE PROFILE (HPAP) TRAINING SCHEDULE

ATHLETE TRAINING SCHEDULE

Use the template provided below to outline your weekly training schedule (days and time).Provide details and duration for the training sessions in each of the spaces.

DAY OF WEEK MORNING TRAINING AFTERNOON / EVENING TRAINING

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

Additional comments:Additional comments:Additional comments:

TOTAL WEEKLY TRAINING HOURS: _____________

PART 3B.


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Bill Crothers Secondary School New Student ApplicationSubmission Procedure Check-List

Print this page and include it with your application. Ensure all sections are complete.

All applicants must submit the following.

General Information [Part 1A]

Student Sport Information [Part 1B]

Student & Parent/Guardian Responses [Part 1C]

Teacher Reference Form [Part 2A] -- See below if being sent separately.

Coach Reference Form [Part 2B] -- See below if being sent separately.

Two Grade Reports (must be submitted with a school seal if non-YRDSB)

Grade 8 students must submit grade 7 final report and grade 8 Interim Report.

Grade 9 students must submit grade 8 final report and grade 9 Midterm Report.

Students in grades 10-12 must submit current credit counselling summary, final report cards from previous year, and current midterm report.

IEP (If applicable)

Non-refundable application fee: $30.00 cheque payable to Bill Crothers Secondary School

High Performance Athlete Profile applicants must submit the supplementary application:

Sport Information [Part 3A]

Athlete Training Schedule [Part 3B]

Please indicate if any of the following forms are being sent separately:

Teacher Reference Form

Coach Reference Form

Submit all of the above information in a 9x12 envelope. On the outside of the envelope, the applicant must include their name, current grade, and current school.

All applications must be submitted to:


The application submission deadline is Thursday, November 29, 2012

Applications will only be considered once all forms are completed and submitted to Bill Crothers Secondary School. Late applications are only assessed if space and programming are available.

Student Name: ________________________________________________! Current Grade: _______ of 8

page 1 of 8 part 1a. for office use only general

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