fairfax county public schools college partnership program · 2014-03-14 · student’s signature...

________________________________________ ________________________________________ Student’s Signature Parent’s Signature

Fairfax County Public Schools

College Partnership Program 3877Fairfax Ridge Road

2nd floor, Fairfax, VA 22030

2014-2015 APPLICATION FOR ADMISSION

The College Partnership Program is a program designed to increase the academic aspiration and enrollment of students in college, particularly first generation college and minority students. Services include academic counseling, college visits, and parent and community involvement.

Factors for Consideration (CPP students are not required to meet every one of these criteria):

First generation college student (first in family to attend a U.S. based institution)

Demonstrates the ability to achieve and maintain a minimum GPA of 2.5 (must meet)

Is a member of one of the NCLB subgroups identified as being in the achievement gap (See Application

Instructions)

Demonstrates a willingness to pursue advanced coursework (i.e. AP, IB, Honors courses)

Demonstrates leadership in school or community activities

Students/Parents accepted into the College Partnership Program are expected to:

Attend CPP monthly meetings (students)

Participate in at least three college visits (students)

Apply to at least three 4-year universities (students)

Complete the Free Application for Federal Student Aid (FAFSA)

Participate in quarterly Parent Sessions (parents)

Be an active participant in various aspects of the College Partnership Program (students/parents)

College Partnership Program Application Deadlines

Applications due to CPP Advocates: April 4, 2014

Applicants notified: Week of May 19, 2014

Orientation and induction for students and parents: Fall 2014

For more information about the College Partnership Program, visit http://www.fcps.edu/is/schoolcounseling/collegesuccess/cpp.shtml Please note: All of the information provided in this application is confidential. This information will be used to determine if we are meeting our program’s mission and goals. This information will only be used internally and not disclosed outside of FCPS.

Application Checklist:

Completed and signed application Copy of unofficial transcript (current high school students) or grade report (current 8th grade

students)

Two letters of recommendation, (one must be from a teacher or school counselor)

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Fairfax County Public Schools College Partnership Program (CPP)

College Success Program 3877 Fairfax Ridge Road, 2nd floor

Fairfax, VA 22030 Phone: 571-423-4410 FAX: 703-279-5211

2014-2015 HIGH SCHOOL APPLICATION INSTRUCTIONS Thank you for applying to the College Partnership Program (CPP). This application packet includes the following materials:

• Application Form (5 pages): All sections of this form must be completed by the applicant, except for Section 2 (page 4), which must be completed by, or with the assistance of a parent/guardian. A parent/guardian MUST sign the application on page 4.

• Two Recommendation Forms: All applicants must provide TWO (2) recommendations from adults who know the applicant and can recommend him/her for the CPP. One recommendation MUST be from a teacher or school counselor who is familiar with the applicant’s academic work. The other recommendation may come from a teacher or another adult (such as an athletic coach, youth group leader or employer). The recommending adults MAY NOT be members of the applicant’s family. The two recommenders are instructed to return their completed forms to the applicant in a sealed envelope by April 4, 2014. DO NOT OPEN THE SEALED ENVELOPES. Attach them to the completed application.

COMPLETING THE APPLICATION

• Follow all directions carefully. • Please PRINT all information neatly in BLUE or BLACK INK only. (No colors. No pencils.) • Additional information and definitions to assist you in completing your application appear below. • Attach two letters of recommendation and a copy of your transcript (report card for middle school students) to the application.

Applications due to CPP advocates: April 4, 2014 Applicants notified: Week of May 19, 2014 Orientation and induction for new students and parents: Fall 2014 (Newly accepted students and parents

will be notified of the time and location)

For more information about the College Partnership Program, visit http://www.fcps.edu/is/schoolcounseling/collegesuccess/cpp.shtml

Fairfax County Public Schools

NCLB SUBGROUP DEFINITIONS

• Black (A person having origins in any of the Black racial groups of Africa.) • Hispanic (A person of a Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish cultural group,

regardless of race.) • Students with Disabilities: A student served at any time during the school year by a special education program in which

students are instructed and monitored based on decisions defined by an Individualized Education Program (IEP). This also includes students receiving services under a 504 plan.

• Students Who Are Limited English Proficient: A student who is identified as Limited English Proficient (LEP), when used with respect to an individual, means an individual:

• who is aged 3 through 21; • who is enrolled or preparing to enroll in an elementary school or secondary school; (i) who was not born in the United States or whose native language is a language other than English; (ii) (I) who is a Native American or Alaska Native, or a native resident of the outlying areas; and (II) who comes from an environment where a language other than English has had a significant impact on the individual’s level of English language proficiency; or (iii) who is migratory, whose native language is a language other than English, and • who comes from an environment where a language other than English is dominant; and whose difficulties in speaking, reading, writing, or understanding the English language may be sufficient to deny the individual (i) the ability to meet the State’s proficient level of achievement on State assessments (described in section 1111(b)(3) of the No Child Left Behind Act); (ii) the ability to successfully achieve in classrooms where the language of instruction is English; or (iii) the opportunity to participate fully in society

• Students Who Are Economically Disadvantaged: Students eligible for free and reduced price lunch.

Last Name _________________________ First Name ________________________ ID Number _________________

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College Partnership Program (CPP)

College Success Program 3877 Fairfax Ridge Road, 2nd floor

Fairfax, VA 22030 Phone: 571-423-4410 FAX: 703-279-5211

2014-2015 HIGH SCHOOL APPLICATION

SECTION 1: STUDENT INFORMATION (To be completed by you, the applicant) PRINT CLEARLY Use Blue or Black Ink Only Applicant Name: Last First FCPS Student ID Number:

Address: Number and Street City Zip Code Home Phone: ( )

Gender: Male Female Date of Birth: (Month/Day/Year) / /

I live with: Father Mother Both Parents Guardian Primary Language Spoken in Home:

Parent(s)/Guardian(s) Last Name:

Current Grade Level: School I now attend (2013-2014): School I will attend in 2014-2015:

College Interest and Advanced Academic Program Participation:

1. Are you currently taking any honors, pre-AP, pre-IB, AP and/or IB classes? No Yes

2. Are you willing to pursue an advanced high school curriculum by taking honors, AP and/or IB classes? No Yes Not sure

3. Do you want to attend college? No Yes Not sure 4. Are you a member of AVID, EIP or the Pathways Program?

No Yes If “Yes,” which one? ___________________________________________

Fulfillment of Program Requirements:

If you are accepted into the College Partnership Program, are you willing to fulfill the following program requirements: Attend monthly CPP meetings

No Yes Attend three college visits

No Yes Complete three college applications

No Yes Complete the Free Application for Federal Student Aid (FAFSA)

No Yes

Family Academic History:

1. Has either of your parents/guardians graduated from college? No Yes

2. Is anyone in your immediate family (siblings or parents) currently enrolled in college? No Yes

If “Yes,” who and where? _______________________________________________________


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SECTION 2: PARENT INFORMATION (To Be Completed by, or with, your parent/guardian)

FATHER/GUARDIAN INFORMATION Name: Last First Occupation/Job:

Home Address: Number and Street Name City State Zip Code Home Phone:

( ) _____ - __________ Work or Cell Phone:

( ) _____ - ________ E-mail Address:

Educational Background:

Some High School High School Graduate Some College College Graduate Graduate Degree (Master’s degree or higher) College attended (name and location): _____________________________________________ Degree earned: _________________

MOTHER/GUARDIAN INFORMATION Name: Last First Occupation/Job:

Home Address: Number and Street Name City State Zip Code Home Phone:

( ) _____ - __________ Work or Cell Phone:

( ) _____ - ________ E-mail Address:

Educational Background:

Some High School High School Graduate Some College College Graduate Graduate Degree (Master’s degree or higher)

College attended (name and location): _____________________________________________ Degree earned: _________________

STUDENT/FAMILY INFORMATION 1. Is your student a member of any of the following groups as identified by NCLB (No Child Left Behind) as being in the

achievement gap: • Black • Hispanic • Students with Disabilities • Students who are Limited English Proficient (or ESOL) • Students who are Economically Disadvantaged

[See NCLB subgroup definitions in Application Instructions-page 2]

No Yes (If yes, how many groups?)_____________________________

2. Number of brothers and/or sisters of student: _______ Age(s) of brother(s)/sister(s): ________________

3. Are any of these brothers or sisters currently participating in the CPP or have they participated in the CPP in the past?

No Yes (If yes, who?) ______________________________________________

PERMISSION TO RELEASE STUDENT RECORDS I hereby grant permission for the release of my child/student (fill in name) ________________________________________’s secondary school grades and standardized test scores to the Fairfax County Public Schools’ College Success Program (CSP) Program Manager and designated CSP and FCPS personnel for use in consideration of the student for selection to the 2014-2015 College Partnership Program. __________________________________________________ ________________________________________________ Parent’s Signature Parent’s Name (PRINT) Relationship to Student: Father Mother Guardian Date: _____/____/ 2014


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SECTION 3: ACTIVITIES AND STUDENT ESSAY (To be completed by the applicant)

SCHOOL AND COMMUNITY ACTIVITIES Instructions: Please list below the five most important (to you) school and/or out-of-school or community activities in which you participate or have participated during the last two years. Identify any leadership positions you have held and any awards or honors you have received.

Activity (Name and Describe) Leadership Position Award or Honors


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STUDENT WRITING SAMPLE

Instructions: Choose one of the following essay topics, and respond in an essay no longer than 500 words. You may write your responses neatly in the boxes provided below or you may write or type your responses on a separate sheet of paper, if preferred. (If you are including a separate sheet of paper, write “see attached” in the spaces below.)

Essay Topics 1. If you could travel anywhere in time or space, either real or imagined, where would you go and why? 2. Indicate a person who has had a significant influence on you, and describe that influence. 3. Tell us about a time when you failed. How did you react? What if anything did you learn? 4. You just put a message in a bottle and threw the bottle out to sea. What is the message? 5. Tell us about a time when you changed your mind about something that mattered to you. What led to that change? 6. Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.


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SECTION 4: RECOMMENDATION INFORMATION (To be completed by the student) Instructions: All applicants must provide TWO (2) recommendations from adults who know the applicant and can recommend the student for the CPP program. One recommendation MUST be from a teacher or school counselor who is familiar with your academic work. One recommendation may come from a teacher or another adult (such as an athletic coach, youth group leader or employer. The recommending adults MAY NOT be members of the applicant’s family.

Recommender #1

Teacher or School Counselor Name of Recommender:

Phone Number or E-Mail Address of Recommender:

Current School Where Recommender Works:

How do you know this adult? Current or Past School Counselor Current or Past Teacher

Recommender #2 Other Adult Recommender

Name of Recommender: Phone Number or E-Mail Address of Recommender:

How do you know this adult?

Current or Past Teacher or School Counselor (School Name: __________________________) Other Adult (Explain how you know this Recommender, below.)

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Fairfax County Public Schools College Partnership Program

2014-2015 RECOMMENDATION FORM

Student Name: Last First Student’s Current School:

Instructions for the Recommender: Please provide the following evaluation for the above-named student, who is applying for the FCPS College Partnership Program (CPP) for high school students. The CPP is a program designed to encourage students (particularly first-generation college, economically disadvantaged, and minority students) to maximize their academic achievement and to provide additional support and encouragement as they prepare for, and apply to, college. Services provided by the CPP include academic counseling, college visits, and parent/community education programs. Please return this completed form to the student in a sealed envelope on or before April 4, 2014. Thank you for your assistance.

OBSERVATIONS Please answer the following questions based solely on your personal observations of the student applicant.

If you have not personally observed the traits or actions listed below, check the “cannot assess” box. 1. This student works well in a group setting.

Always or Almost Always On Occasion Rarely Cannot Assess

2. This student follows through with commitments on assignments/obligations. Always or Almost Always On Occasion Rarely Cannot Assess

3. This student displays a strong work ethic.

Always or Almost Always On Occasion Rarely Cannot Assess 4. This student demonstrates the skills and ability to successfully participate in advanced academic high school course work.


ADDITIONAL COMMENTS Please comment below on how the candidate would benefit from the support offered by the CPP in relation to academics, college preparation, self-concept, and/or social skills. Please feel free to provide any additional information that will assist in the evaluation of this applicant for the College Partnership Program. You may write your responses in the box provided below or you may write or type your response on a separate sheet of paper, if preferred. (If you are including a separate sheet of paper, write “see attached” in the space below and include the student’s name and school on the top of the attachment and sign/date the attachment and this form.) Recommendation: I Highly Recommend I Recommend with Reservation I Do Not Recommend

Name of Recommender (Print):

Signature of Recommender and Date: ____/____/2014

Title:

How do you know the applicant? Teacher (Course: ________________________) School Counselor Other (explain) :

How long have you known the applicant?

PLEASE RETURN THE COMPLETED FORM TO THE APPLICANT IN A SEALED ENVELOPE ON OR BEFORE April 4, 2014.

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Fairfax County Public Schools College Partnership Program

2014-2015 RECOMMENDATION FORM

Student Name: Last First Student’s Current School:

Instructions for the Recommender: Please provide the following evaluation for the above-named student, who is applying for the FCPS College Partnership Program (CPP) for high school students. The CPP is a program designed to encourage students (particularly first-generation college, economically disadvantaged, and minority students) to maximize their academic achievement and to provide additional support and encouragement as they prepare for, and apply to, college. Services provided by the CPP include academic counseling, college visits, and parent/community education programs. Please return this completed form to the student in a sealed envelope on or before April 4, 2014. Thank you for your assistance.

OBSERVATIONS Please answer the following questions based solely on your personal observations of the student applicant.

If you have not personally observed the traits or actions listed below, check the “cannot assess” box. 1. This student works well in a group setting.


2. This student follows through with commitments on assignments/obligations. Always or Almost Always On Occasion Rarely Cannot Assess

3. This student displays a strong work ethic.

Always or Almost Always On Occasion Rarely Cannot Assess 4. This student demonstrates the skills and ability to successfully participate in advanced academic high school course work.


ADDITIONAL COMMENTS Please comment below on how the candidate would benefit from the support offered by the CPP in relation to academics, college preparation, self-concept, and/or social skills. Please feel free to provide any additional information that will assist in the evaluation of this applicant for the College Partnership Program. You may write your responses in the box provided below or you may write or type your response on a separate sheet of paper, if preferred. (If you are including a separate sheet of paper, write “see attached” in the space below and include the student’s name and school on the top of the attachment and sign/date the attachment and this form.) Recommendation: I Highly Recommend I Recommend with Reservation I Do Not Recommend

Name of Recommender (Print):

Signature of Recommender and Date: ____/____/2014

Title:

How do you know the applicant? Teacher (Course: ________________________) School Counselor Other (explain) :

How long have you known the applicant?

PLEASE RETURN THE COMPLETED FORM TO THE APPLICANT IN A SEALED ENVELOPE ON OR BEFORE April 4, 2014.

fairfax county public schools college partnership program · 2014-03-14 · student’s signature...

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