Author: patriciam.mctigue

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2018-2019 Application

Part I: STUDENT (To be completed by student APPLICANT)
SECTION I-A: STUDENT INFORMATION
Student’s Legal Name / (Last, First, MI)	Student’s Preferred or Nickname	Gender	Current Grade	CMS ID#
Home Address	City, State, Zip Code		Middle School Attending/Attended?
The Independence Academy of Engineering is not a magnet or choice school. In order to gain acceptance to the AOE, you MUST be assigned to Independence High School. Please check the appropriate box: / To the best of my knowledge, I reside in the current Independence High School district.
Student Phone Number / (How can we best contact you?)	Student E-Mail Address		Student Birth Date (MM/DD/YY)
Parent/ Guardian Name(s)	Parent/Guardian Contact Information: / Email Address: / Phone:
Race/ Ethnicity (optional) / Language (optional): Is English the primary language spoken in the home? If “NO” please list any other languages spoken in

YES

NO

Asian

Hispanic/ Latino

Pacific Islander

Black/ African American

Native American/ Alaskan Native

White/ Caucasian

Other/ Multi Racial

YES

NO

the home.

In compliance with federal law, Charlotte-Mecklenburg Schools administers all education programs, employment activities and admissions without discrimination against any person on the basis of gender, race, color, religion, national origin, age or disability.

SECTION I-B: STUDENT ESSAY. Essay must be typed and attached to the application with student name in the upper right hand corner. The essay should be no longer than one page in length. Choose ONE of the following:
ESSAY #1: Using your persuasive written talents, explain why you are interested in participating in the Academy of Engineering? / ESSAY #2: A good portion of your class time in the academy will be spent in collaborative work. You will work with teachers, fellow students, and business/community leaders in a way that requires teamwork, compromise, and active participation. In a well-written essay, explain how your participation in the collaborative setting of the academy will benefit you. Consider, but don’t limit yourself to the following questions in your response: / What skills and personality traits do you have that make you especially suited for collaborative activities? / What personal learning and growth do you expect to gain from having the opportunity to be a part of such collaborative activities? / ESSAY #3: “Engineers like to solve problems. If there are no problems handily available, they will create their own problems.” Scott Adams—What is a major problem that an engineer has created a solution for? Explain how the solution has benefitted society. / Reminder—your essay should be no longer than one page and be a true essay, NOT a statement.

Part II: UNDERSTANDING/ CONSENT FORM (To be read and signed by Parent/Guardian AND Student Applicant)
This section ensures that parents/guardians and applicants fully understand their responsibilities if applicants are selected to participate and become a part of the Independence High School Academy of Engineering. Signatures of both / student applicant and parent/guardian are required.
I understand that students are responsible for attendance to all Academy activities. Leaves-of-absence are granted for students only in the case of medical or family emergencies. I consent to these terms. / I understand that the Independence High School Academy of Engineering is partially publically funded and that the names, addresses and school affiliation of students completing the program will become a matter of public record. I consent to such information becoming a matter of public record. / I understand that the student and/or family must arrange transportation to and from all Academy events and activities. I consent to providing transportation to and from the Academy, and in the event the Academy officials deem transportation necessary in case of illness, disruptive/non-participatory behavior, or other unforeseen circumstances. / I understand that Independence High Academy students may attend Academy sanctioned events off campus. I consent to my student being transported to selected venues off campus with legal drivers authorized by the Academy. / I understand it may be necessary for Academy officials to obtain emergency assistance in case of accident or sudden illness and the the parents/guardians of students will be responsible for costs of medical care. I consent to emergency treatment of my student during his/her participation in the Academy. / I understand that Academy students may be surveyed regarding Academy classes, activities, administration, and student perceptions. I consent to Academy student surveys. / I understand that students may be interviewed and/or photographed or filmed as part of news coverage or promotion of the Academy (including website). I consent to such interviews, photographs, and film being published or broadcast. / I understand that work generated at the Academy may be shown publicly on the Academy website and in other venues associated with the Academy. Work chosen for this reason will be represented as illustrative of high standards and performance. I consent to the public showing of student work associated with the Academy. / I understand that the Independence High School Academy of Engineering will establish and enforce reasonable rules necessary to create a safe, healthy, and respectful environment. I consent to reasonable rules and understand that I must adhere to the Independence High School honor code. A copy of the Academy Handbook will be provided to each student.

I certify that I have read and understood the foregoing information and consent to its terms and that the information in this application is correct to the best of my knowledge. I hereby consent to my son/daughter’s nomination to the Independence High School Academy of Engineering.
Parent/ Guardian Signature	Date:
Address, City, State, Zip	Home Phone: / Cell Phone: / Work Phone:
I certify that I have read and understood the foregoing information and consent to its terms and that the information in this application is correct to the best of my knowledge. I hereby submit my name for nomination to the Independence High School Academy of Engineering.
Student Applicant’s Signature	Date:

Part III: RECOMMENDATION
SECTION III-A: SCHOOL RECORD (Academy recommended EOG level 4’s and 5’s)
STEP 1: Please attach a copy of your most recent report card, historical grades or transcript. The Independence High School AOE does not accept or reject students based on academic performance; however, these courses are rigorous and may require students to enroll in foundational classes before they can be scheduled with the cohort. / STEP 2 (optional): Letters of recommendation from teachers, counselors, community members, etc. are not required but will be considered when submitted with the completed application. Such letters should be on letterhead if applicable.
SECTION III-B: EVALUATION (To be completed by a faculty member, counselor, and/or administrator)
Please note: The Academy of Engineering follows a rigorous academic pathway. Please only recommend students who are willing and able to fully participate in the entire Academy experience, including classwork/projects, student organizations, internships, and field trips. / Please check the appropriate box using this scale: / 1=indicates a low demonstrated ability to 5=a high demonstrated ability / Please attach a separate page providing comments or examples to support your evaluation. Include any unusual circumstances in the applicant’s life that create a particular need for consideration. Supporting statements MUST be on letterhead and signed.
SCALE: 1(low ability) 2 3 4 5 (high ability)
Applicant has the ability and desire to cope successfully with advanced concepts, materials and activities.
Applicant has a positive attitude about exploring new and different concepts and areas of study, including those in which he or she may not be proficient.
Applicant shows maturity and consideration for others.
Applicant has demonstrated the ability to meet or exceed expectations of behavior.
Applicant can participate fully in a demanding schedule of activities and classes.
Applicant can use self-directed time wisely.
Applicant is likely to participate fully in collaborative experiences, including student-created projects and presentations.

Signature of Recommending Person	Printed Name:	Relationship to Student
Recommender’s Email Address:
Special Instructions: This page, along with any additional teacher recommendations, should be attached to the completed application in a sealed envelope with the recommending persons signature over the sealed portion of the envelope. Failure to follow the application instructions will result in a delay and may cause your application to be denied.