Gender: Female Ethnicity: Birthdate: (Mon/Date/Year) (Number) (Street) (City) (Zip)

Transcripción

1 Application Form Due March 17 th, 2017 Student's Name (Last, First): Gender: Female Ethnicity: Birthdate: Male (Mon/Date/Year) Home Address: (Number) (Street) (City) (Zip) Phone Number: ( ) Alt. Phone Number: ( ) Address(es) (Parent and Student): Current School: Middle School Counselor s Name: Current Science Teacher: Current Math Teacher: How did you hear about the program? Do you have a relative that attends (or has attended) EMSI? If so, list the student s name Do you receive free or reduced lunch? Will you be the first member of your family to attend college? Español à

2 Instituto en verano de Ingeniería, Matemáticas, y Ciencias Formulario de aplicación Debido el 17 de marzo, 2017 Nombre del estudiante (Apellido, Nombre): Sexo: Femenino Etnicidad: Fecha de nacimiento: Masculino (Mes/Día/Año) Dirección de casa: (Calle) (Ciudad) (Zip) Número de teléfono: ( ) Numero alternativo: ( ) Correo electrónico ( ): _ Escuela: Nombre de consejero(a) de Middle School: Maestro(a) de ciencias actual: _ Maestro(a) de matemáticas actual: Estás tomando Algebra I este año escolar? Cómo te enteraste acerca del programa? Tienes familia que asiste (o ha asistido) a este programa (EMSI)? Si respondiste sí, escribe el nombre del estudiante Solamente para el propósito de nuestras estadísticas Recibes el almuerzo gratis o de un precio bajado en la escuela? Serás el primer miembro de tu familia que ingresará a la universidad?

3 Math Teacher Recommendation Please complete this form and mail or it by March 17 th, Name of Student Instructor s Name Math Course Teacher: At EMSI, most of our courses are project-based or focused on group problem solving. Please comment below on how you feel, from your experience, that this student will handle the peer-to-peer interaction and our creative learning environment. Please honestly mark the box that best exemplifies this student s performance in each of these areas in your class this year. Listens and follows teacher s directions Demonstrates ability to work independently Perseveres in spite of difficulty Works cooperatively Enjoys new challenges Is self-motivated Is intellectually curious Is prepared for class Establishes friends easily Respects others Displays leadership potential Consistently Usually Sometimes Seldom Overall Recommendation Highly Recommend Recommend Recommend with Reservations Do Not Recommend Signature of Teacher: Please complete this form and return it by March 17 th, 2017 to: Houston, Texas (or it to EMSI@kinkaid.org)

4 Science Teacher Recommendation Please complete this form and mail or it by March 17 th, Name of Student Instructor s Name Science Course Teacher: At EMSI, most of our courses are project-based or focused on group problem solving. Please comment below on how you feel, from your experience, that this student will handle the peer-to-peer interaction and our creative learning environment. Please honestly mark the box that best exemplifies this student s performance in each of these areas in your class this year. Listens and follows teacher s directions Demonstrates ability to work independently Perseveres in spite of difficulty Works cooperatively Enjoys new challenges Is self-motivated Is intellectually curious Is prepared for class Establishes friends easily Respects others Displays leadership potential Consistently Usually Sometimes Seldom Overall Recommendation Highly Recommend Recommend Recommend with Reservations Do Not Recommend Signature of Teacher: Please complete this form and return it by March 17 th, 2017 to: Houston, Texas (or it to EMSI@kinkaid.org)

5 Records Form Due March 17 th, 2017 REQUEST FOR RECORDS Please fill out this form and include it with student records. This set of records should include: 1) A copy of the most recent report card 2) A record of test scores (STAAR, Stanford if available, etc.) 3) A transcript with past grades for middle school Please mail all documents to: Houston, TX (or to: EMSI@kinkaid.org) Student Name (printed) Current School Anticipated High School Grade Date of Birth Address (Number, Street, City, State, Zip) Parent/Guardian Signature Student Signature