Brenda Wildes Megan Grogan Geoffrey Picard

Lyman Memorial High School 917 Exeter Rd. Lebanon, CT 06249 Ag Office: (860)-642-7759

BRENDA WILDES MEGAN GROGAN GEOFFREY PICARD Animal Science Plant Science Natural Resources & Mechanics [email protected] [email protected] [email protected] 917 Exeter Rd. Lebanon, CT 06249 Ag Office: (860)-642-7759

DIRECTIONS- APPLICATION FOR ADMISSION

This application consists of several parts. No student may be considered until all parts of the application have been submitted. It is the responsibility of the individual applicant to submit the application as a complete package.

1. The application is to be completed by the student and his/her parents/guardians, and returned as soon as possible.

2. The Student Data Form is to be completed by any qualified person at the sending school (guidance counselor, teacher, principal).

3. A personal interview with the student and his/her parent/guardian is required. In most cases, the Agricultural Science and Technology Center may be visited during the school day or immediately following the end of classes.

4. Return completed application to:

Ag Department Secretary Lyman Memorial High School Application917 Exeter Rd DeadlineLebanon, for the CT 06249 Academic Year: 1st Friday in January

Interviews will be concluded by:

2nd Friday in February Acceptance 917 ExeterNotification Rd. Lebanon, by: CT 06249 Ag Office: (860)-642-77592nd Friday in March

Commitment Date:

1st Friday in April Name: Date:

APPLICATION PACKAGE CHECKLIST

All items listed below should be completed and included with the student’s application.

Student essay included (Must be completed). -Why they should be accepted into our program

Parents/guardians and students have reviewed the Acceptance Requirements and the Program Participation Criteria.

Application for Admission form completed.

Program Participation Criteria document is signed by parents/guardians and student.

Lebanon School District Student Enrollment Form completed.

Student Data Form, completed by appropriate party of student’s present school, attached.

Signed Lyman Memorial High School Release included.

Student transcript for 7th and 8th grades attached.

Student attendance record included.

Return completed package to: Ag Department Secretary Lyman Memorial High School 917 Exeter Rd Lebanon, CT 06249

917 Exeter Rd. Lebanon, CT 06249 Ag Office: (860)-642-7759

PROGRAM PARTICIPATION CRITERIA:

1. Academic Achievement: Students must maintain full-time credit status and must maintain passing grades in all classes. Students failing any class during the school year will be reviewed for dismissal. Students must earn a passing grade in Agricultural Science & Technology courses each quarter. Students must be prepared for class and have all appropriate materials for class instruction.

2. Social Responsibility & Citizenship: Students must show appropriate behavior and follow the school rules at all times, as stated in the Lyman Memorial High School Student Handbook. Failure to follow the school rules will result in dismissal from the Agricultural Science & Technology Program and, as appropriate, Lyman Memorial High School.

3. Work Ethic & Behavior: Students must complete all of the assigned activities in each of the lab areas (Agricultural Mechanics Shop, Greenhouse, Animal Lab, Barn Areas). Written class work (term papers, oral reports, projects, etc.), and tests will be assigned by individual instructors.

4. Classes: Students must participate in all of the instructional areas of the program.

5. Clothing & Safety Glasses: Students must wear suitable clothing and provide their own coveralls if they want additional clothing protection. Safety glasses must be worn in shop areas and will be supplied by the Agricultural Science & Technology Program. Students are responsible for their safety glasses and if lost, replacement glasses will be at the student’s expense.

6. Field Trips: Students are required to attend certain field trips and other activities. These trips will be announced in advance and may include a Saturday activity.

7. Supervised Agricultural Experience (SAE)- Students must develop and maintain and agriculturally related project. Students need to keep their project up-to-date and show development over the course of their four years in the Agricultural Science & Technology Program. All requirements for the SAE must be met.

8. FFA- Students must be active in FFA during all 4 years in the program and pay annual dues.

9. Ag Safety- Safety is a big priority on our program however; students need to be aware of the inherent risk involved in an Agricultural Science & Technology Program.

10. Dismissal From the Program- Any student denied admission to a program of vocational agriculture or who is about to be dismissed from such a program shall be given an opportunity to request an informal review of his/her case before a Review Committee at a Regional Vocational Agriculture Center. The Review Committee shall be composed of at least, but not limited to the following representation: a member of the vocational agriculture staff, an administrator from the school where the vocational agriculture program operates, a member of the operating board of education or their administrative representative, a member of the sending board of education or their administrative representative, and a member of the regional vocational agriculture consulting committee. Such student may make a request in writing, to the proper vocational agriculture center, addressed to the administrator responsible for such center, for a review of his or her case. Any such request shall be made within 15 days of such action. The said committee shall conduct such review within 20 days of receipt of such request. The committee through the operating board of education shall within 10 days of such review, notify in writing, the student, and the sending board of education of its decision. This decision shall be final and binding upon all parties. Dismissal will occur at the end of a semester or at the end of the school year.

I have read the above requirements and understand them fully.

Student Signature: Date:

Parent/Guardian Signature: Date: Lyman Memorial High School does not discriminate in any of its programs or activities on the basis of race, color, religious creed, age, marital status, national origin, sex, sexual orientation, or physical disability.

917 Exeter Rd. Lebanon, CT 06249 Ag Office: (860)-642-7759

APPLICATION FOR ADMISSION Name: Sex: Phone:

Address:

Town: State: Zip Code:

School/Grade: /

Age: Date of Birth: / /

Mother: Work/Cell Phone:

Father: Work/Cell Phone:

Email:

1. As an 11th and 12th grade Ag-Science student, what areas of the Ag-Science & Technology Program may you want to focus on?

______Animal Science ______Plant Science ______Ag-Mechanics ______Natural Resources

2. Will you have an opportunity for agricultural work experience at home?

If Yes, Please describe:

3. Please list the names, addresses and phone numbers for three (3) references:

Name: Address: Phone:

Parents/Guardians: I wish to have my daughter/son considered for enrollment in the Agricultural Science & Technology Program at Lyman Memorial High School. I am aware that acceptance of this application is subject to review by a high school committee. I further agree that is my daughter/son is accepted into this program, that she/he will conform to the rules of the Agricultural Science & Technology Program and of Lyman Memorial High School.

Parent/Guardian Signature: Date:

LYMAN MEMORIAL HIGH SCHOOL “Home of Bulldogs”

917 EXETER RD LEBANON, CONNECTICUT 06249 JAMES APICELLI OFFICE: (860) 642-7567 FAX: (860) 642-3521 ANN BIRELL Principal GUIDANCE: (860) 642-5687 Assistant Principal

Release of Information: Students entering Lyman Memorial High School

Name of Student: Grade: DOB: / /

Street Address:

I give permission to:

Name of School:

To forward the following information to Lyman Memorial High School; 917 Exeter Road, Lebanon, CT 06249.

Academic Record (Includes grades, discipline, and attendance records)

Health Record

Planning & Placement Team Record

Psychological Record

Parent/Guardian Name (Printed): LEBANON SCHOOL DISCTRICT STUDENT ENROLLMENT FORM

I. STUDENT INFORMATION:

Students Legal Name: Last First Middle Grade registering for: Date of registration: Starting date: Gender: Date of Birth: Place of Birth: Social Security #: US Citizen: yes no Resident Address: House# Town State Zip Mailing Address: House# Town State Zip Home Phone #: Emergency Phone #: Foster Child: yes no If Yes, Case Worker’s name: Phone #: Race (check one): White, Non-Hispanic Black, Non-Hispanic Hispanic/Latino American Indian Asian Other

Predominant Language Spoken by student: Predominant Language Spoken in the home: Limited English Proficient: yes no Other minor (to age 18) children in the family (names and birth dates)

Child’s Name DOB Child’s Name DOB

II. PARRENT INFORMATION:

Father’s Name: Employer: Occupation: Phone numbers: Home: Cell: E-mail: Mother’s Name Employer: Occupation: Phone numbers: Home: Cell: E-mail: Legal Guardian (if applicable): Employer: Occupation: Phone numbers: Home: Cell: E-mail:

Student is living with (check appropriate space (s)). Mother Father Step-Mother Step-Father Guardian Relative Friend Foster Parent

If parents are divorced, name of parent who has custody of the child: Assignment of custody: Date Town: State: Assignment by which court:

If a Non-Residing biological parent would like school information, please fill out the following: Name: Relation: Address: Town: State: Zip Code: Phone: E-mail:

Has the parent/guardian worked in agriculture related employment in the past two years? Yes No Has the student received CT Migratory Children Services? Yes No Tuition Student; list town of residency: Does the student ride the school bus? Yes No

**If the student is residing with a Non-Family Member, an Affidavit of Residency must be completed by a parent/guardian and returned with this form.**

III. EDUCATIONAL INFORMATION:

Name of last school attended: Address: # Street Town State Zip Did the student attend nursery school/preschool? Yes No Does the student receive special service? Yes No Speech Resource Room Counseling Other: Does the student have any illnesses or physical conditions that the school should be aware of? Yes No If yes please explain: Has the student previously attended Lebanon Public Schools? Yes No If yes and the name has changed, please list former name:

Person completing this form: Relationship:

I have received and read the contents of the Student Handbook Yes No Student Signature: Date: Parent/Guardian Signature: Date:

Parent Connect information and registration requested: Yes No

For Office Use Only

Records requested Records received Health Records received

Date student entered Perm # Assigned

*This information is requested for statistical purposes but the State of Connecticut only. Admission to Lebanon Public Schools is based on the applicant with regard to sex, age, creed, national origin or handicap.*

917 Exeter Rd. Lebanon, CT 06249 Ag Office: (860)-642-7759 STUDENT DATA FORM:

To be completed by guidance counselor, administrator, or teacher.

Your cooperation is requested in providing information about the student applicant to the Lebanon Regional Agricultural Science & Technology Program at Lyman Memorial High School. We require a transcript of the student’s achievement for 7th and 8th grade (year-to-date for 8th grade).

Name of Sending School:

Mailing Address: Street/PO Box Town Zip

Phone: Fax:

Name of Party completing this form:

Position:

Student Applicant: Grade: Age:

1. Does this student have a sincere interest in our program? Please explain.

______

2. Please describe the student’s behavior at your school (i.e. motivation and cooperation with teachers and staff, interactions with other students).

______

3. Please provide the student’s attendance/tardy record for 7th and 8th grade.

ALL REQUESTED INFORMATION AND RECORDS MUST BE PROVIDED FOR STUDENT TO BE CONSIDERED FOR ADMISSION