APPLICANT'SNAME_______________________,_________________,_____Birthday//

LAST FIRST MI M/D/Y

APPLYINGForGRADE:678

Millikan Affiliated Charter Middle School 2013-2014 Academy Application for all Academies
All Applicants must: (a) Complete the Intent to Apply found at www.millikanmiddleschool.org (b) Provide a self addressed stamped envelope upon application submission (c) Complete Academy Application: (page 1-2) and attach: i) -a copy of last three years report cards ii) -a copy of last 2 years CST scores (or any other standardized test scores) iii) -copies of other supporting materials (IEPs, Independent School assessments/notes, etc.) (d) Provide Teacher Recommendation Form (pages TR 1&2) to current school teacher with addressed, stamped envelope NO APPLICATION WILL BE CONSIDERED WITHOUT THE REQUIRED ATTACHMENTS Math and Science Academy candidates must: - take the math placement test on Friday, February 8, 2013 to qualify Performing Arts and Film Candidates may submit: i) a CV (resume) or complete description of training in dance, music, or theatre ii) a portfolio of work, where applicable (e.g., costume design, edited film, story boards, music composition) Directions: Applicants will be considered independently for admission to each program as indicated below. Applicants may apply for up to 3 programs and will be considered for admission only to those programs. If you apply to more than one program, please indicate your preference by marking "1, 2, 3...". Letters indicate submission procedure for each program. Priority Submission Requirement ___CIVICS ACADEMY a, b ___ENVIRONMENTAL STUDIES ACADEMY a, b ___FILM ACADEMY a, b ___MATH ACADEMY a, b, c ___SCIENCE ACADEMY: A STEM SCHOOL a, b, c ___PERFORMING ARTS a, b, d, e Submission procedure requirements: a) All applicants must have completed the Intent to Apply found at www.millikanmiddleschool.org, or request a hard copy from the Performing Arts Magnet Office at 818-528-1610 b) Mail or hand carry c) Must take math placement test on Friday, February 8, 2013 to qualify d) Schedule and complete audition e) Application and CV must be received by the February 8, 2013 deadline OR 1 week prior to audition Application submission begins Monday, December 3, 2012 We will begin accepting applications on December 3, 2012. For priority consideration, the final deadline for receipt of academy applications is February 6, 2013 regardless of audition, interview, or math placement test dates. All applications submitted after the final deadline of February 6, 2013 will be considered after earlier applications have been accepted or denied. Invitation to Audition or Interview Upon review of the application, Science, Environmental Studies, Civics and Film Academy candidates will receive notice to interview. Math Academy does not require an interview. Performing Arts Academy candidates will need to make an appointment to audition. Please see the Performing Arts page at millikanmiddleschool.org for instructions. Candidates taking the math placement test for the Math or Science Academy must be at Millikan at 3:15pm on Friday, February 8, 2013. Location to be announced. Acceptance Letters Letters regarding status of applications to any academy will be sent out beginning March 1, 2013. Students will be asked to confirm or decline notice of acceptance within 10 days of mailing, allowing opportunity to offer the seat toanother student. NOTE: Placement in an Academy DOES NOT guarantee acceptance into Millikan Affiliated CharterMiddle School. You must also meet residency requirements, OR you must apply for and receive a transfer permit (i.e. SAS etc.)
Millikan Middle School, 5041 Sunnyslope Ave, Sherman Oaks CA 91423 (818 528-1600) millikanmiddleschool.org Academy Application

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APPLICANT'SNAME_______________________,_________________,_____Birthday//
LAST FIRST MI M/D/Y

APPLYINGForGRADE:678

Current School __________________________ Current Grade _____

NUMBER / STREET

Current Teacher ____________________________

CITY ZIP CODE

Home Address ________________________________________ _______________________________ _______________ Home phone Contact Cell Phone
This is the primary form of communication. Please print carefully

Alternate Phone

Best Contact Email Address: __________________________________________ Parent/Guardian #1:

First Last Email Phone

Parent/Guardian #2:_
First Last Email Phone

SPECIAL SERVICES Does your student receive special education services at his/her current school? Has your student ever had an IEP at a previous school? If YES, have you attached a copy of the IEP? Does this student have a Section 504 Plan at his/her current school? If YES, have you attached a copy of the students Accommodation Page? Does this student have any difficulties that interfere with his/her ability to go to school, or to learn?

CIRCLE ONE Yes Yes Yes Yes Yes Yes No No No No No No

Explain:____________________________________________________________________________________ Has this student been identified Gifted or Talented by LAUSD? Highly Gifted Voice Intellectual Dance High Achievement Drama Specific Subject Music Visual Art Yes No

If YES, please attach a copy of identification letter.

Please confirm you have attached to this application copies of the following: I have attached a copy of my childs last 2 years California Content Standardized Test Scores (CST).
If your child has not taken this test, please attach copies of the results of whatever "achievement tests" and "ability tests" your child has taken in the last two years.

I have attached a copy of my childs last 3 years report card or progress report I have attached (if applicable), a copy of my childs State Identified Gifted verification
I understand that if my child is accepted into a Millikan Academy, enrollment is not guaranteed unless we meet residency requirements, OR apply for and receive a LAUSD Transfer Permit (e.g. SAS, School of Choice, etc). I have given the Teacher Recommendation Form and a pre-addressed, stamped envelope to my childs current teacher. I understand that Teacher Recommendations are confidential and are mailed by the teacher directly to Millikan Affiliated Charter Middle School. If (I/my child) am accepted into this Program, I understand that (I/my child) am expected to maintain a GPA above 3.0 with no U in any subject, attend all field trips, participate in all Academy activities both in and outside of the classroom (including fundraising), and demonstrate responsible and respectful behavior at all times.

STUDENTS SIGNATURE __________________________________________________________ PARENT'S SIGNATURE _________________________________________________________

DATE ___________________ DATE __________________

Millikan Middle School, 5041 Sunnyslope Ave, Sherman Oaks CA 91423

(818 528-1600)

millikanmiddleschool.org

Academy Application

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