Visual and Performing Arts Center

Crossroads Arts and Science Early College An Early College High School Partnership with Catawba College, Mitchell Community College and Iredell-Statesville Schools 476 North Center Street - Statesville, NC 28677 - Phone: (704) 978-0034 - Fax: (704) 978-0035

Part A: Parent Section: Demographic Information

Student Name: ______Gender: □ Female □ Male Last First Middle

Student ID #: ______Date of Birth: ______

Home Address: ______House/Apt # Street City State Zip

Mailing Address: ______House/Apt # Street City State Zip

Home Phone #: ______Student Mobile #: ______

Student lives with: both parents mother only father only mother/step dad father/step mom other:______How long have you lived with the above? ______

Middle School Attending: ______High School Attendance Zone: ______

Father/Guardian’s Name: ______Last First Middle email address

Home Phone #: ______Cell #: ______Work #: ______

Employer: ______

Mother/Guardian/s Name: ______Last First Middle email address

Home Phone #: ______Cell #: ______Work #:______

Employer: ______

Please List Information of Other Children at Home or Away at School: Name Grade Level Age School of Attendance

Updated 11/30/2015

Equal Opportunity Information: Notice: The information on this page will not be used to determine whether or not you are accepted into an Early College Program. This information is for statistical purposes only. Iredell-Statesville Schools, Mooresville Graded School District, and Mitchell Community College do not discriminate on the basis of race, color, religion, national origin, sex, age, or disability.

Race / Ethnicity: Optional __ Asian __ Black or African American __ Hispanic __ American Indian/Alaskan Native __ Native Hawaiian/Pacific Islander __ White/Caucasian __ Multi-Racial __ Other ______

Educational Services: Does this student receive services in any of the following programs: Check all that apply. __ Special Education (Individualized Education Plan/IEP) __ Section 504 Plan __ Academically and Intellectually Gifted (AIG) Math __ Academically and Intellectually Gifted (AIG) English __ I am not aware if my child receives services in these programs. __ My child does not receive services in any of these programs.

Student Section: Rank your level of interest in the following elective areas: (All are beginning classes.)

A for first choice, B for second choice, and C for third choice.

_____ Art _____ Band If not interested in the arts, select: _____ Chorus _____ Personal Finance _____ Dance _____ Entrepreneurship _____ Guitar _____ Piano _____ String Orchestra _____ Theatre Section D: Statement of Commitment for Students and Parents

By signing below, I acknowledge that all information is accurate and complete as stated within this application and recognize that acceptance into the Crossroads Arts and Science Early College requires a commitment of one year. If at the end of the first year a student is unwilling or unable to continue studies at CROSSROADS, he/she will be reassigned to the high school of his/her attendance zone. I understand that CROSSROADS students are expected to be responsible members of the high school and college communities. Any attendance or behavior problems will be sufficient cause to rescind assignment to CROSSROADS. I also understand that parents/guardians must provide transportation at times during the school year (ex. Tutoring, after-school activities, field trips, inclement weather for college classes, etc.)

Updated 11/30/2015 ______Student Name (printed) Student Signature Date ______Parent/Guardian (printed) Parent/Guardian Signature Relation Date ______Parent/Guardian (printed) Parent/Guardian Signature Relation Date

Updated 11/30/2015 Section E. Records Release Form (Please give this form to data manager)

Student Name: ______

Power School ID: ______Date of Birth: ______

Consent to Access Records: I hereby authorize counselors and/or institutions to release transcripts, educational records (including but not limited to Individualized Education Plans (IEP), Section 504 Plans, Academically and Intellectually Gifted (AIG) records, and ESL records), transcripts, attendance, discipline, testing results, mid-term grade reports, and final grade reports regarding the above named student to the Crossroads Arts and Science Early College. This authorization also allows Mitchell Community College or other post-secondary institutions to release enrollment information, class schedules, mid- term grade reports, and semester grade reports to the Crossroads Arts and Science Early College.

______Applicant Name (printed) Applicant Signature Date

______Parent/Guardian Name (printed) Parent/Guardian Signature Date

*Due to limited space, CROSSROADS reserves the right to interview applicants to help determine entry status. All students and parents should be aware that an interview may be required before a student is accepted for enrollment.

You must request the following documents have them submitted by your school counselor or data manager. _____ Historical Grade Report _____ Daily Attendance Report Summary _____ Explore Scores _____ Test results _____ Discipline Report ___ Enclosed ___ NA (no report needed) _____ IEP/504/ESL plan ___ Enclosed ___ NA

To the data manager: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS). CROSSROADS is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and earn a high school diploma and an Associate’s Degree or two years of college credit. Return the attach release form to requested records in a sealed envelope directly to CROSSROADS via mail at 476 N. Center St., Statesville, NC 28677 by November 20, 2017 .

Updated 11/30/2015 Crossroads Arts and Science Early College An Early College High School Partnership with Catawba College, Mitchell Community College and Iredell-Statesville Schools 476 North Center Street - Statesville, NC 28677 - Phone: (704) 978-0034 - Fax: (704) 978-0035

* * * * * * * * * * * * * * * * * * * * * * * * MATH TEACHER RECOMMENDATION * * * * * * * * * * * * * * * * * * * * To the Student: Please fill in your information in the box below and give this form to a CURRENT academic teacher.

To the Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS). CROSSROADS is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and earn a high school diploma and an Associate’s Degree or two years of college credit. Please use this form to share your perceptions of how this student will meet the academic and social responsibilities of the school. Return the completed recommendation form in a sealed envelope directly to CROSSROADS via mail at 476 N. Center St., Statesville, NC 28677 by November 20, 2017 .

Teacher Name: ______Email address: ______How long have you known the applicant? ______Current subject grade: ______

Poor Superio N/A or Not 1 2 3 4 5 r 6 Observed Academic Ability in Subject Daily Preparation Participation Motivation (Very Important) Verbal Communication Skills Problem-Solving Ability to Work as a Team Member Leadership Skills Assignments submitted on time & complete

1. Do you recommend this student to the CROSSROADS program (ALL Honors and College level)? Please explain: ______

2. Please describe this student’s attitude/work ethic (include any behavioral issues). ______

3. Please describe this student’s at-risk factors (for example: dropping out, peers ostracize, misfit-ness, IEP/ESL/504, underachiever, requires strong school/teacher support, recent adoption/group home, socio- economic status, etc.) ______

4. What is the next recommended level of math for this student? __Foundations of Math I __Math I __ Math II

Teacher Signature ______Date ______

* * * * * * * * * * * * * * * * * * * * * * * * LANGUAGE ARTS TEACHER RECOMMENDATION * * * * * * * * * * * * * * * * To the Student: Please fill in your information in the box below and give this form to a CURRENT academic teacher.

Teacher Name: ______Email address: ______How long have you known the applicant? ______Current subject grade: ______

Do you recommend this student to the CROSSROADS program (ALL Honors and College level)? Please explain: ______

2. Please describe this student’s attitude/work ethic (include any behavioral issues). ______

Updated 11/30/2015 Teacher Signature ______Date ______

* * * * * * * * * * * * * * * * * * * ** COUNSELOR/ADMINISTRATOR RECOMMENDATION * * * * * * * * * * * * * * * * * To the Student: Please fill in your information in the box below and give this form to your CURRENT counselor.

To the counselor: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS). CROSSROADS is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and earn a high school diploma and an Associate’s Degree or two years of college credit. Please use this form to share your perceptions of how this student will meet the academic and social responsibilities of the school. Return the completed recommendation form in a sealed envelope directly to CROSSROADS via mail at 476 N. Center St., Statesville, NC 28677 by November 20, 2017 .

Counselor Name:______Email Address: ______

1. How long have you known the student? ______2. Describe any at-risk factors for this student. (Examples include, but are not limited to: lack of family support, IEP/ESL/504, needs extensive teacher support, recently adopted or placed in group home, severely ostracized by peers, likely to drop-out, misfit-ness, socio-economic status, etc.) ______

3. All classes at CROSSROADS are at the Honors level, and college level. Explain their potential success in rigorous Classes and preparedness for Honors and College courses: ______

4. Describe the student’s attitude, work ethic, motivation, and include any behavioral concerns. ______

5. CROSSROADS students have more flexibility and freedom in their school day than traditional schools. Based on your experience with this student, do you believe they have the maturity to manage this freedom? Will they attend college classes as required, not abusing the freedom they are given? If no, please explain.

Does this student receive services in any of the following programs? Check all that apply.

______IEP ______504 Plan ______ESL ______AIG/math ______AIG/Reading ____ No services

Counselor Signature ______Date ______

Updated 11/30/2015 Application for Admission – 2018/2019 School Year

CHECKLIST For student’s use only Check off as you have completed and have each of the following ready to turn in:

______Application Part A: Demographic Information (completed by the parent/guardian)

______Application Part B: Student Section

______Application Part C: Statement of Commitment

______Records Release Form: (both student and parent/guardian must read and sign)

______Both Teacher Recommendation Forms should be returned to you in a sealed envelope or sent directly to us from the teacher. The Counselor Recommendation Form will be sent directly to CROSSROADS from the counselor. Please make sure that your recommendation forms have been sent. CROSSROADS staff is not responsible for tracking them down.

You must request the following documents have them submitted by your school counselor or data manager . _____ Historical Grade Report _____ Daily Attendance Report Summary _____ 7th and 8th grade report cards _____ Test results _____ Discipline Report ___ Enclosed ___ NA (no report needed) _____ IEP/504/ESL plan ___ Enclosed ___ NA

Please return this completed application (with all paperwork, records, and recommendations) in person or postmarked no later than November 20 th , 2017 to the following address:

Crossroads Arts and Science Early College 476 North Center Street – Statesville, NC 28677 Phone: (704) 978-0034 Fax: (704) 978-0035

Updated 11/30/2015