Gradeà / 9 / 10 / 11 / 12 / Value / Total / Counselor’s Signature
P SAT (one time)
(165 selection index) / 2
SAT Reasoning Test
(one time) 1700 or above / 2
PLAN (one time)
25 composite or above / 2
ACT (one time per year)
25 composite or above / 2
A.P. Test (each) 3 or above / 2 / No Signature needed
National Merit Commended Student / 2 / No Signature needed
National Merit Semifinalist / 3 / No Signature needed
National Merit Finalist / 4 / No Signature needed
EXTRACURRICULAR ACTIVITIES
Grade à / 9 / 10 / 11 / 12 / Value / Total / Teacher’s Signature
Art- Gold Keys Regional / 1
Art- Gold Keys New York / 2
Art- CC Exp. Program Blue Ribbon / 1
Academic Challenge Team / 1
Speech & Debate / 2
Publication in Connection or
Reflections (each year) / 1
JSA / 1
American Legion State Buckeye Boys’/Girls’ / 2
HOBY / 1
Drama Club / 2
Model United Nations / 2
Music Honors Groups (individual only) Solo/Ensemble / 2
Ohio/American Math League: Cum. Score of 4 / 1
Participation in AMC / 1
Participation in OCTM / 1
Robotics Team / 2
BCSD V-Team Member / 2
Look Up To Cleveland / 2
Cleveland Clinic Internship / 2
University Circle Leadership Program / 2
Other: Must be Pre-Approved by Administration (in/out of school) / 1
LOCAL AWARDS
9 / 10 / 11 / 12 / Value / Total / Advisor/Teacher’s Signature
Summa Cum Laude 4.25 and above Semester GPA / 4 / Obtain unofficial Transcript from
Guidance Office
Magna Cum Laude 3.85 to 4.299 Semester GPA / 2
Cum Laude 3.5 to 3.849 Semester GPA / 1
Student of the Quarter (awarded by teacher nomination at June Assembly / 2 / No Signature needed
National Honor Society (each year) / 2 / No Signature needed
Name ______Grade_____ I.D. # ______
Application deadline is April 21, 2017.
ADMINISTRATORS COUNSELORS
Mr. Vincenzo Ruggiero, Principal Mrs. Laura Johnson
Mr. Mark Mucha, Assistant Principal Ms. Sarah Kolis
Mr. Anthony Riccio, Assistant Principal Dr. Dawn Ruebensaal
Mr. Gregory Soos, Assistant Principal Mr. Robert Schuff
Mrs. Linda Wolf
Applicant’s Name ______I.D. # ______
Grade ______I am applying for _____ 1st Pin _____ 2nd Pin ______3rd Pin
Total Points this year ______
Turn completed application into the Activities Office. See Mrs. Huszai with any questions.