The Cleveland School of Architecture and Design

Cleveland School of Architecture and Design at John Hay Campus

2017-18 Student Application Coversheet (Page 1 of 6)

Cleveland School of Architecture and Design at John Hay Campus

2075 Stokes Boulevard - Cleveland, Ohio 44106

“The primary goal of the Cleveland Metropolitan School District is to become a premier school district in the United States of America”

Completed applications will be accepted between

September 13, 2016 and April24, 2017

Please submit your Complete Application Package in person or by mail to Merry Beth Pietila, Student and Family Recruiter, room 115 Cleveland School of Architecture and Design or by email: . Office (216) 838.8200.

Application revised 9-1-16.

Student Name Last: ______First: ______

School: ______Current Grade: ______

School Address: ______

School Phone: ______Principal: ______

A completed application package requires ALL of the following items:

Student Application Coversheet

Student Information/Essay

Parent/Guardian Information

English Teacher Recommendation

Mathematics Teacher Recommendation

Principal or Guidance Counselor Recommendation

Official copy of most recent standardized test scores

Official copy of most recent report card with attendance data

Official copy of IEP, ETR and/or 504 Plan if applicable

Cleveland School of Architecture and Design

School Office Number: (216) 838.8200Tianna Ferguson, Principal

GPA Requirement: 3.0

Relatives who are students of the small schools at John Hay or alumni:

Name ______Small School______Relationship ______

2017-18Student Information/Essay (Page 2 of 6)

______

(Please print) Student Last First Middle

Homeaddress______

City ______State ______Zip ______

Gender: M _____ F _____ Date of Birth ______

Student Essay: Please tell us about your goals and accomplishments. What are your favorite subjects in school, are you involved in any extracurricular activities and why would you like to attend Architecture & Design at John Hay? (Use back of page or separate sheet, if needed.)

______

Student Signature ______Date ______

2017-18Parent/Guardian Information(Page 3 of 6)

Student Name______

Please complete the followingParent/Guardian information:

_____ Mother _____Guardian _____Father _____Guardian

Name ______Name ______

E-mail ______E-mail ______

Home address ______Home address ______

City ______State ______Zip______City ______State ______Zip______

Home Phone ______Home Phone ______

Cell Phone ______Cell Phone ______

Name of employer ______Name of employer ______

Work Phone ______Work Phone______

Does your child require any special personal and/or academic support at home or at school? (For example, IEP, ETR, 504 Plan, counseling or medical accommodations etc.) Please provide details in the space below.

______

Is there anything else that you would like the Committee to know about your child? ______

Has the student ever attended or applied to John Hay Campus in the past? _____ No _____Yes

If yes, to which small school? ______

I/We have provided accurate information and agree that School of Architecture & Design at John Hay Campus may contact the school and persons listed herein for further information.

Signature of parent/guardian ______Date ______

2017-18English Teacher Recommendation (Page 4 of 6)

Student’s Name______Current Grade Level ______

Please evaluate the student based on the following characteristic categories listed below by placing an “X” in the appropriate column. Thank you!

RATING
CATEGORY / EXCELLENT / GOOD / FAIR / POOR / NO BASIS FOR JUDGEMENT
Ability to Follow Directions
Ability to Meet Deadlines
Ability to Resolve Conflicts
Ability to Solve Problems
Ability to Work with Others
Classroom Behavior
Effort/Self- Motivation
Organizational Skills
Study Skills

How well does this student master the content of your course?

______

Is there anything else that you would like The Committee to know about this student? ______

Based on the student’s overall performance, I recommend this student with:

 Strong Enthusiasm  Mild Enthusiasm  Without Enthusiasm

Length of time acquainted with student: ______Name of School: ______

Recommendation Completed By: ______Phone Number:______

Signature ______Date ______

2017-18Mathematics Teacher Recommendation (Page 5 of 6)

Student’s Name______Current Grade Level ______

Please evaluate the student based on the following characteristic categories listed below by placing an “X” in the appropriate column. Thank you!

How well does this student master the content of your course?

______

Is there anything else that you would like The Committee to know about this student? ______

Based on the student’s overall performance, I recommend this student with:

 Strong Enthusiasm  Mild Enthusiasm  Without Enthusiasm

Length of time acquainted with student: ______Name of School: ______

Recommendation Completed By: ______Phone Number:______

Signature ______Date ______

2017-18 Principal/Guidance Recommendation(Page 6 of 6)

Student’s Name______Current Grade Level ______

Please evaluate the student based on the following characteristic categories listed below by placing an “X” in the appropriate column. Thank you!

How does this student fit into the culture of your school?

______

Is there anything else that you would like The Committee to know about this student? ______

Based on the student’s overall performance, I recommend this student with:

 Strong Enthusiasm  Mild Enthusiasm  Without Enthusiasm

Length of time acquainted with student: ______Name of School: ______

Recommendation Completed By: ______Phone Number:______

Signature ______Date ______