LockhartPrideHigh School Application

Academic / Non-Traditional / Alternative High School

1503 N. Colorado Lockhart, Texas 78644

(512) 398-0130; Fax (512) 398-0132

Laurie Lay, Principal Sharon Konvicka, Counselor

Connie Amaya, Secretary/Registrar

Application Checklist

Eligibility: You must qualify in all areas.

Be 16 to 21 years of age

Have at least one at-risk factor

Have one full year of high school experience

Application Request: ALL the following are required in order for your application

packet to beconsidered.

Application – all lines complete,

A high school transcript and scores,

Current shot record (immunizations),

Copy of Birth Certificate

Procedure: Please complete the application packet (all the items listed in the Request) and turn it in or send it to the PrideHigh School office (address above).

PrideHigh School is a school of choice and we take that very seriously.

You will be called to set up an interview or to tell you why Pride is not the best program for you at this time.

Student Name: ______

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Reviewed: ______, Principal’s initials Date: ______

__ Accepted

__ Declined, Reason: ______

LockhartPrideHigh School Application

Academic / Non-Traditional / Alternative High School

1503 N. Colorado Lockhart, Texas 78644

(512) 398-0130; Fax (512) 398-0132

Laurie Lay, Principal Sharon Konvicka, Counselor

Connie Amaya, Secretary/Registrar

NOTE: A copy of each of the followingMUSTaccompany the application

TRANSCRIPT, EOC SCORES, SHOT RECORD & BIRTH CERTIFICATE

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  • Full Name of Applicant ______Age: ______

Date of Birth: ______Social Security #: ______-______-______

Address: ______,TX Zip:______

Home Phone #: ______Parent Work #: ______

  • Medical Condition:______Medications: ______
  • Parent/Guardian Name(s): ______
  • Parent's Signature: ______Date of Application: ______

LastSchool Attended: ______# of credits earned: ______Current grade:______

Are you behind due to absences: N Y Do you work after school: N Y # of hours/week:_____

  • Counselor'sSignature (LHS): ______

Complete the following ONLY if you, the student, are pregnant or a parent.

Child’s Mother: ______; Father: ______

Have you registered with the Cub House for childcare? Y N Explain: ______

Child’s name: ______DOB: ______

  • Check current or prior involvement with the following:

Juvenile Probation/TYC PO:______Phone #: ______

Give details here: ______

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For official use only: _X_ Non-Traditional, _X_ AT-RISK: ___ Failed EOC

___LEP/ESL, ___CPS, ___Homeless, ___Failed: ___grade, ___Below 70, ___Pregnant/Parent,

___Facility (MH, TYC), ___ DAEP (DMC), ___ Expelled, ___ Probation/Parole, ___Drop-out

Parent/Student Conference held on (day/date/time): M T W TH F /______/______

Student Accepted: ___Yes, entry date: ______; ___No, reason: ______

Student Name: ______Date: ______

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General Background

  1. How do you qualify for LockhartPrideHigh School? Failed EOC:___ Alg I ___ Bio ___Eng I ___Eng II ___US Hist ___ LEP/ESL, ___CPS, ___Homeless, ___Failed: ____What Grade,

___Below 70 in 2 classes, ___Drop-out, ___Pregnant/Parent, ___Facility (MH, TYC)

___ DAEP (LDMC), ____ Expelled, ____ Probation/Parole

  1. Name of the person who referred you to PrideHigh School. ______
  1. How do you expect your educational experience to be different? ______

______

______

  1. What are your concerns: gossiping, threats, fights, drug use, alcohol use, being ignored, gangs, rude / obscene language, ridicule from others, sexual assault, birth control, financial aid, college admission, money, family problems, poor grades, poor test scores, my attitude?
  1. Who has been your biggest fan, the main person in your life and how has that person helped you so far. ______

______

How has this person been a support to you?______

______

  1. What personal and/or academic strengths do you have that will be important to your school success? ______

______

  1. Circle any / all of the following self-defeating or disappointing choices you have made:

a. failing grades b. poor test scoresc. abusive/obscene language

d. un-excused absences e. excessive absencesf. fighting, pushing, shoving

g. truancy h. dropping-outj. tardiness to classes / school

k. drug use k. alcohol usel. failing to turn in assignments

  1. What events or personal tendencies have caused you to do poorly in your academics, attend-ance and/or behavior choices during your previous school experiences? ______

______

______

  1. Explain what your plan is, so that any negative choices and problems you had before will be handled differently at Pride. ______

______

  1. How do you plan to get to school on time every day? ______

______

What is your alternate plan, if the original transportation is unable to get you to school?

______