QUEST ACADEMY
GAP PROGRAM
GAP Program
COURSES OFFERED:
ENGLISH: Eng. I Eng II Eng III
MATH: Algebra I Geometry Math Models Algebra II
SCIENCE: Biology IPC Chemistry Physics
SOCIAL STUDIES: World Geography World History U. S. History
HEALTH: Health Ed. (.5)
PHYSICAL EDUCATION: Foundations of Physical Ed (.5 ) Team Sports (.5)
SPEECH: Communication Application (.5)
FOREIGN LANGUAGE: Spanish I Spanish II
FINE ARTS: Art I Music
ELECTIVES: Creative Writing (.5 ) Psychology (.5) Sociology (.5) BIM (1.0)
Interior Design (.5 ) Medical Terminology (.5) Accounting 1 (1.0)
Journalism (.5 ) Practical Writing (.5)
APPLICATION and CONTRACT
GAP PROGRAM
Recovery and Drop-out Prevention
Student Name:______Grade:______
Last First Middle
Student Id #: ______RISD Home Campus: ______
Ethnicity: ______Gender: Male / Female Age as of Sept. 1:______
SS #: ______Birth Date: ______
Student Email address: ______
HOUSEHOLD INFORMATION FOR STUDENT
Home Address______Apt/Lot # ______
City ______Zip______Phone # ______
PARENT/GUARDIAN INFORMATION
Adult Male: ______Relationship to student: ______
Last First
Daytime phone: ______Cell Phone/Pager:______
Email address:______
Adult Female: ______Relationship to student: ______
Last First
Daytime phone: ______Cell Phone/Pager:______
Email address: ______
Circle the grade(s) student has attended in Rockwall Schools: K 1 2 3 4 5 6 7 8 9 10 11 12
Transportation:
___ student will drive
___ parents will drop off/pick up student
___ student will ride bus
Student Name:______Grade:______
Last First Middle
Student History
Circle YES or NO on all that apply and EXPLAIN on the following blank lines:
Does student receive Special Education services? Yes No (talk to diagnostician)
Does student receive Section 504 accommodations? Yes No (talk to 504 Coordinator)
Does the student have excessive absences? Yes No (has truancy been filed)
Please explain any yes(s) circled above: ______
This section is very important in determining priority of acceptance. Please check the reason(s) you are requesting a place in the GAP Program:
____failed two/more core courses last school year ____has been retained
____did not pass EOC ____is now pregnant or a teen parent
____was placed in DAEP during the current ____was expelled preceding school year TEC 37.007
or preceding school year TEC 37.006 ____currently on parole, probation, deferred
____reported through PEIMS as drop out prosecution, or other conditional release
____is a student of limited English proficiency ____in the custody/care of CPS
____is homeless (defined by Title X)
Please explain the checks and add any additional reasons or information that would be helpful to us in making an admission decision.
______
______
STUDENT CONTRACT:
GAP PROGRAM:
I understand that it is a privilege to attend the GAP Program. I agree to abide by the policies of the school and will be cooperative and respectful to the faculty and staff. I am aware this is a module and/or computer driven program that now has a minimum pace requirement. I am committed to regular daily attendance in an effort to complete a minimum of 10 credits each school year. If this is not accomplished, I understand that I will be subject to truancy charges, dismissal from the program, or a mandatory meeting with the Academic Review Committee to reevaluate my ability to successfully complete this program.
Signature of Student: ______Date: ______
PARENT CONTRACT AND CONSENT:
CONSENT FOR PROGRAM
I hereby consent for my daughter/son to participate in the GAP PROGRAM.
I understand the attendance and minimum credit requirements and I agree to support my child in successfully accomplishing each. Upon request, I will be available to meet with the faculty and staff to review my child’s performance.
CONSENT FOR COUNSELING
I hereby consent for my daughter/son to participate in individual and group counseling sessions for the purpose of moving toward mental growth and maturity.
Signature of parent/guardian: ______Date: ______
Referral: To be completed by home campus Counselor
QUEST ACADEMY/GAP Program
Recovery and Drop-out Prevention Programs
Important: Please make sure the following information is completed and all records attached before sending the referral to the Quest Academy.
Student’s Name______Grade______DOB ______
Student I.D. #______Name of Home School______
Does this student receive Special Education services? ____ Yes ____ No
If so, how are they served? ______Resource ______CMC
In which subject/s does the student receive special education services/modifications?
______
Does this student have a special education referral in progress?______Students who have special education referrals in progress cannot begin classes at Quest Academy until eligibility for special education services has been determined.
Note: An ARD committee must approve the application for a student receiving SpEd services – see your diagnostician.
Does this student currently:
____ receive 504 accommodations? ____ receive LEP/ESL services?
____ meet state criteria for At-Risk? ____ have truancy charges filed?
Reason for referral: ______
Please attach copies of the following Student Records for the application to be complete:
1. front and back of the transcript including EOC scores
2. personal graduation plan
3. schedule
4. last report card issued
5. latest STAAR Confidential Student Report
6. if a section 504 student – a copy of all accommodations
7. If a special education student- see diagnostician to set up meeting
Participation in the GAP Program is a privilege. Filing an application does not automatically ensure acceptance. Our mission is to serve those students who are in need of alternative education (see page 2 on the application). Please refer those students who most demonstrate those needs.
Counselor’s Signature______Date______
2017-2018