Public Schools of Robeson County and

Robeson Community College

Biotechnology 2007 Summer Academy

High School Student Application

(Type or print legibly)

NAME (last, first, middle):______

BIRTHDATE:______

GENDER: MALE FEMALE

US CITIZEN: YES NO*

*IF NO, DO YOU HAVE A PERMANENT RESIDENT VISA? YES NO

CLASSIFICATION /ACADEMIC YEAR Sophomore Junior Senior

MAILING ADDRESS:______
______

COUNTY:______

TELEPHONE # ______

PERMANENT ADDRESS (If different from the above.):______

______

PERMANENT TELEPHONE # ______CELL TELEPHONE # ______

EMAIL ADDRESS:______

HIGH SCHOOL:______

CUMULATIVE GRADE POINT AVERAGE:______

 Session One: June 18, 19, 20, 21 Transportation provided for Purnell Swett High School students

 Sessio Two: July 9, 10, 11, 12 Transportation will not be provided to anyone

FIELD TRIP PERMISSION FORM

PUNELL SWETT HIGH SCHOOL

Post Office Box 1210

Pembroke, N.C. 28372

My son, daughter, ______, has my permission to ride the minibus

from Purnell Swett High School daily to and from Robeson Community College.

I understand that reasonable precautions will be taken to insure his/her safety. I will not

hold school authorities or accompanying adults responsible for any accident. In case of

an emergency, I give permission to the accompanying adult to secure and approve

appropriate medical care.

______is adequately insured by

STUDENT

______, Policy Number ______.

(NAME OF INSURANCE COMPANY)

______

DATE(SIGNATURE OF PARENT/GUARDIAN)

CHAPERONES: Sue Patterson PHONE: 910-521-3253

Tina HuntPHONE: 910-521-3253

DESTINATION: Robeson Community College

TIME OF DEPARTURE: 8:30 a.m.

EXPECTED TIME OF RETURN: 1:00 p.m.

METHOD OF TRANSPORTATION: Mini bus

APPROXIMATE COST OF MEALS: $0

Emergency Contact:______Relationship:______

Name

Phone Number:______

The Public schools of Robeson County Career Technical Education program and Robeson Community college are working together to offer a Biotechology summer academy. Students that are eligible to apply to the program must be a rising 10th, 11th, or 12th grade student. The student must be able to attend the program for the entire four days and may not participate in other programs concurrently.

The application deadline is May 25, 2007.

This program will offer students the opportunity to activily work in a laboratory setting completing experiments that relate to Biotechnology.

First Session: June 18-21 2007

The students will arrive at Purnell Swett High School at 8:30 am and then take a minibus to Robeson Community College. At the College the students will complete a Biotechnology acitivity, eat lunch and then return to Purnell Swett High School by 1:30 pm to take bus home . On the last day of the academy the students are encouaged to have their parents participate in an experiment. Then enjoy a powerpoint presentation about the work the students completed during the week.

Second session: July 9-12.

The student will be expected to provide their own transportation to and from Purnell Swett High School. The minibus will leave Purnell Swett High School at 8:30 am sharp. At the College the students will complete a Biotechnology acitivity, eat lunch and then return to Purnell Swett High School by 1:30 pm for pick-up to return home. On the last day of the academy the students are encouaged to have their parents participate in an experiment. Then enjoy a powerpoint presentation about the work completed during the week. No Transportion to and from Purnell Swett High School is provided for this session.

If you attend the first session you can not attend the second session.

Biotechnology 2007 Summer Academy

STATEMENT OF INTEREST

(Type or print legibly)

NAME (last, first, middle):______

Your statement should address:

  • why you are applying to the Biotechnology Summer Academy
  • what you hope to achieve as a participant
  • what your career goals are
  • how this program will advance you closer to your career goals
  • discuss any aspects you feel will provide a better picture of your capability, motivation, and interests
  • please indicate the degree program(s) you intend to pursue after completing high school

(This section should be typed or printed, using this sheet-front and back, or a separate sheet.)

FACULTY RECOMMENDATION

Applicant:

Please give this form and a self-addressed envelope to the person whom you have asked to recommend you. The recommender should return the completed form to you in a sealed envelope so that you can include it with your other application materials to be sent to the Program Coordinator, postmarked by JuLY 15, 2005.

APPLICANT'S NAME:______

RECOMMENDER'S NAME:______

In accordance with the Family Education Rights and Privacy Act of 1974, you may waive your right to inspect this recommendation by signing the statement below. Should you not waive your right, you may have access to this form as a SPGRE participant.

I hereby waive my right of access to this recommendation.

SIGNATURE: DATE:

For the Recommender:

This application is for participation in a Agricultural Biotechnology Summer Academy aimed at students who are most likely to choose an education and career in the sciences.

How long and in what capacity have you known the applicant? ______

In comparing the applicant with others you have known who entered similar programs, check the appropriate category for each item below regarding your assessment of the student. Please use the following reference points:Exceptional=Top 10%; High=At least in the top 25%, Modest=in the 50% to 75% range; Low=Bottom 50%. Please do not feel compelled to respond to items addressing areas where your knowledge of the student is limited.

NOT OBSERVED / LOW / MODEST / HIGH / EXCEPTIONAL
1. Maturity and reliability
2. Ability to get along with others
3. Leadership ability
4. Research skills
5. Writing skills
6. Analytical skills
7. Mathematical skills
8. Potential as a graduate student
9. Indicated plans for attending
a higher level institution

Please provide additional comments that may be helpful in accurately assessing the applicant (Please feel free to write on the back or attach additional sheets). Thank you for your assistance and for completing this form.

SIGNATURETITLE DATE

E-MAIL ADDRESS PHONE NUMBER_

APPLICATION CHECKLIST

The following items are a completed application set:

Application Form – (can be e-mailed)

Statement of Interest – (can be e-mailed)

Mini bus permission slip (sent to program coordinator or included in a mailed application packet)

1 Faculty Recommendations (sent to program coordinator or included in a mailed application packet)

Return completed application to:

Sue Patterson or Tina Hunt

P.O. Box 1210

Pembroke, N.C. 28372

(910) 521-3253 Phone

(910) 521- 2956 Fax

Completed Application Forms and Statement of Interest can also be e-mailed to:

or:

Faculty recommendations can be mailed separately.

Completed applications must be postmarked on or before May 25, 2007

Internet & Media Acceptable Use Policy Agreement

I have read the Rules and Regulations regarding the Acceptable Use Policy for Internet and Media in the Public School of Robeson County and I understand that this access is designed for educational purposes only. I also recognize that it is impossible to restrict access to all inappropriate materials. However, I accept full responsibility for my compliance with the above Rules and Regulations and hereby agree to abide and ensure that my child is also in compliance. I further understand that any violation will result in loss of access privileges and is also subject to student behavior guidelines of the Public Schools of Robeson County, and local, state, and federal laws.

Please return this form with the application packet and keep the Internet & Media Acceptable Use Policy brochure for your records. I hereby grant permission for my child for each of the areas.

PLEASE CIRCLE

YES NO I hereby give permission for my son/daughter to have Internet access privileges.

YES NO I hereby give permission for my son/daughter to have electronic mail privileges for collaboration within the class and any approved electronic pen-pal programs.

YES NO I hereby grant permission for my son/daughter’s picture and/or video/audio to be taken for use within the school/college/ school website/ college website, or local newspaper. I understand that no student last names will be listed with pictures/video on the Internet.

YES NO I hereby give permission for my son/daughter’s work samples to be posted on the Public Schools of Robeson County and Robeson Community College’s website. All work submitted by students for posting will be listed by first name and/or teacher and grade.

Parent Name (Print)______

Phone______

Parent Signature______

Date______

Student Name (Print)______

Grade______

Student Signature______

Date______

Biotechnology 2007 Summer Academy