Northwest High School

Student Application Date: ______Grade: ______

Student Information Name: ______Date of birth: ______Original Year of Graduation: ______Number of Credits Earned: ______

Address ______Home Number: ______Cell Number: ______Do you have access to a computer at home? □ Y □ N Do you have internet access at home? □ Y □ N Email address: ______Do you participate in extra-curricular activities? □ Y □ N What? ______Do you work? □ Y □ N Where? ______

Parent Contact Information Parents, you may sign up to have a progress report automatically generated. Please provide your email address below and indicate how often you would like to receive an email. Email Address 1: Frequency: Weekly Daily Email Address 2: Frequency: Weekly Daily

Proposed Courses for Credit Recovery/Acceleration in Panther Academy (Core Classes Only) Note students accepted into Panther Academy begin with one course on a trial basis. After a 3-6 week trial period additional courses may be added if there is space, an educational need, and the student is making good progress.

1st Choice: ______2nd Choice: ______

Student statement of Need: ______

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Revised 6/2011 Student: Why do you feel the Panther Academy would suit your personal needs and goals better than CHHS? ______

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Student: What changes and/or commitment are you willing to make to be successful in the Panther Academy? ______

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Parent statement of Need: ______

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Students selected to the program are those who are “at risk” of dropping out or have already dropped out of school. I understand the selection process and, if selected, I will follow the rules and regulations pertaining to Panther Academy.

Being enrolled in Panther Academy is a privilege. Students enrolled in the Academy must demonstrate the desire to complete courses, to attend school, to make good choices while at school in order to be a successful student and to graduate. Not following through with these requirements could result in being removed from the Panther Academy Program.

Students please read and initial below. ____ I understand that I must provide a pair of headphones; if I am not able to purchase a pair of headphones, a pair will be checked out to me.

_____ I understand that I must make academic progress in my Academy course. If progress is not made, then I will be changed back to a traditional class.

_____ I understand that I must be motivated to work independently and ask for help when I need it. It is my responsibility to complete my courses in a timely fashion.

______Parent Initial By initialing, I am indicating that I understand the expectations of the program and that my student must make progress in order to remain a participant in the Academy program.

Student Signature ______Date ______

Parent Signature ______Date ______

Revised 6/2011