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PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOLA Pitt County Schools – Pitt Community College Partnership1959 Warren DriveWinterville, NC 28590252-493-7821APPLICATION FOR ADMISSIONDemographic Data: (This information will be used for State/Local Reports)Student Name:LastFirstMiddleCurrent School:Sex: Male Female- Birthdate / / State of Birthplace:Month DayYearMailing Address: City: ZipHome Address: City: ZipStudent Email Address:Home Telephone Number: Student Cell Phone Number:Ethnicity/Race:American Indian Alaskan Native Asian/Pacific Islander BlackHispanic White Multi-Racial OtherParent/Guardian Information:Mother’s Name: Father’s Name:Guardian (if applicable): Relationship to Student:Mailing Address (if different from student):Parent(s) Work Number: Parent(s) Cell Phone Number:Place of Employment: (M) (F)Parent(s) Email Address:Parent(s) Highest Educational Level Attained (Place an “M” for Mother/”F” for Father) even ifthe parent(s) are not in the home:Did not graduate high school High school graduate Some college/CertificateCompleted Associate Degree Completed Bachelor’s DegreeCompleted Master’s Degree Completed Doctoral DegreeApplications must be fully completed in order to be reviewed.Application deadline is February 24, 2017 and should be submitted to your counselor.Date application submitted to your school counselor1
PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOLA Pitt County Schools – Pitt Community College Partnership1959 Warren DriveWinterville, NC 28590252-493-7821PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOL ADMISSION ESSAYThe Pitt County Schools Early College High School is a rigorous program designed to provide students withan opportunity to earn a High School Diploma and an Associate degree at no cost to the student. Itrequires a strong work ethic and a commitment to success. In 500 words or less, in your own handwriting,explain what you think it will take for you to successfully meet the challenges in completing this program.Provide examples of your work ethic from past experiences in school.2
PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOLA Pitt County Schools – Pitt Community College Partnership1959 Warren DriveWinterville, NC 28590252-493-7821Student StatementSign below if you agree to the following: I understand that my commitment to Pitt County Schools Early College High School is for at leastone full academic year.I expect to complete a two-year degree program while at Pitt County Schools Early College HighSchool.I am able to complete the Future Ready Core Course of Study.I will maintain high academic and behavior standards.I understand that there are no athletic or ROTC programs and limited clubs at Pitt County SchoolsEarly College High School.I understand that Pitt County Schools Early College High School will operate on the Pitt CommunityCollege school calendar, NOT the calendar of Pitt County Schools.I have read these statements and I agree to abide by them as well as the rules and policies of PittCounty Schools Early College High SchoolStudent Signature: Date:Parent/Guardian Statement(To be completed by parent/guardian)Students succeed best when the school, the parent/guardian, and the student work together. Pleasesign below if you agree to the following expectations as parent/guardian: I understand that my child’s commitment to Pitt County Schools Early College High School is forat least one full academic year.I agree to make every effort to ensure my child is in school every day.I agree to attend and support school functions.I understand that my child must be able to complete the Future Ready Core Course of Study.I will encourage and expect high academic and behavior standards from my child.I understand that there are no athletic or ROTC programs and limited student clubs.I understand that Pitt County Schools Early College High School will operate on the PittCommunity College calendar, not the Pitt County Schools calendar.I agree to encourage my child to abide by the rules and policies of Pitt County Schools EarlyCollege High SchoolName of Parent/Guardian and Signature:Date:By my signature below, I agree to the following:I give permission for the Child Nutrition Director in the school district to confirm the student is currentlyeligible for free or reduced price meals at school, or for the principal or guidance counselor to certify thatthe student is eligible for Need Based assistance.Signature of Parent or Guardian: Date:3
PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOLA Pitt County Schools – Pitt Community College Partnership1959 Warren DriveWinterville, NC 28590252-493-7821TO BE COMPLETED BY SCHOOL COUNSELOR OR PRINCIPAL DESIGNEE ONLYBoth the student and parent sections should be completed BEFORE the counselor or principal designeecompletes this section.Applications must be fully completed in order to be reviewed.Student Name: PowerSchool NumberPerson completing form: Title:Please complete the following information about the applicant.Please check one:1. Exceptional Children: Yes NoIf yes, please state area(s) of exceptionalityIf this student is EC, what course of study is he/she pursuing? Please check one:Future-Ready Core Future-Ready Occupational504 Plan: Yes No Accommodations:Is this student AIG? Yes No2. Does this student receive ESL Services? Yes No3. Discipline: Number of Incidents: 7th Grade 8th GradePlease explain any extenuating circumstancesHow many absences did this student have in 7th grade? Currently in 8th GradePlease explain any extenuating circumstances4. Testing Information: Please attach score reports or complete the section below.7th Grade EOG Scores: Math PercentileLevelReading Percentile LevelThe Pitt County Schools Early College school counselor will follow up with you in June to obtain 8thgrade EOG scores (if unavailable at time of application).I verify that the information listed is true and accurate to the best of my ability.Signature: Date:4
PITT COUNTY SCHOOLS EARLY COLLEGE HIGH SCHOOLA Pitt County Schools – Pitt Community College Partnership1959 Warren DriveWinterville, NC 28590252-493-7821Pitt County Schools Early College High School Teacher or Counselor Recommendation(Confidential Information-Please return to student in sealed envelope)Student Name: PowerSchool NumberCurrent School: Grade Level:Recommendation completed by: (Please print)The above student is applying for admission to Pitt County Schools Early College High School, which islocated on the main campus of Pitt Community College. This recommendation is for the 2017-2018 schoolyear. Students enrolled in this program simultaneously complete their high school education and anAssociate Degree or a two-year degree program. Your responses will be valuable in helping the ReviewCommittee to identify which students will benefit and succeed in this program. Without this recommendationform, a student’s application is incomplete and will not be reviewed for admission. If you have anyquestions please contact Principal Wynn Whittington at wynn.whittington@pitt.k12.nc.us or Counselor-Ms.Bernetta Bradley at bradleb@pitt.k12.nc.us at Pitt County Schools Early College High School.Please check any characteristics that apply to this student:bright/intelligentshows leadership capabilitiesdemonstrates artistic abilitiesseeks academic challengesparticipates in class discussioneager to join the adult worlddesires more freedom or independenceshows little/no interest in learningdemonstrates consistent academic effortconsistent discipline problemsperforms to potentialneeds help with career goalsneeds personal attention and encouragementcapable of performing at higher levelfollows through on homework assignmentsretained in gradesdisassociates from middle school activitiesexperiences struggles common to today’s teens (divorce, loneliness, peer pressure, etc.)Evaluate the student’s current performance by circling one in each category.Please assroom Attitude:ExcellentGoodFairPoorComment:Class Work:ExcellentGoodFairPoorComment:Potential for success in college environment (with support):ExcellentGoodFairPoorComment:Additional comments may be written on the back of this form.Signature: Telephone Number: Date:5
A Pitt County Schools - Pitt Community College Partnership 1959 Warren Drive Winterville, NC 28590 252-493-7821 3 Student Statement Sign below if you agree to the following: I understand that my commitment to Pitt County Schools Early College High School is for at least one full academic year.
