You are on page 1of 5

Si necesita traducción de este documento, puede comunicarse con la directora al (361) 698-2425.

CORPUS CHRISTI INDEPENDENT SCHOOL DISTRICT
DEL MAR COLLEGE
Corpus Christi, Texas

COLLEGIATE HIGH SCHOOL
(An Early College High School)
Student Lottery Application
2016 - 2017
Please review the application carefully and ensure all information provided is complete and accurate.
Any application that is incorrect and/or incomplete will not be considered.
SECTION A. GENERAL INFORMATION
___________________________________________________________________
Name of Student (Last)
(First)
(Middle)

_________________________________________
Social Security Number/Student ID Number

___________________________________________________________________ ___________________________________________________
Name(s) of Parent(s)/Guardian(s)
Home Telephone
___________________________________________________________________
Physical Home Address
(Zip Code)

______________________________________________
Business Telephone

___________________________________________________________________
Mailing Address (if different from above)
(Zip Code)

______________________________________________
Parent/Guardian Email

ETHNICITY (circle one)
African American
Hispanic

White

American Indian

Asian/Pacific Islander

My child is in the attendance zone of:
_________________________ High School
Do you currently participate in any special programs? (optional)
Gifted/Talented
Dyslexia/504
Special Education

Speech

Bilingual/ESL

Migrant

GENDER (one)
 Female

DATE OF BIRTH
Month

Day

Year

 Male
Student’s current age: _____________
Student’s current school: ___________
Student’s current grade level: _______

Student’s religion preference:
___________________________

Please indicate any medical conditions that require health assistance:

SECTION B. STUDENT SURVEY
1. What language is spoken most in the home?
2. Do you currently receive free and/or reduced lunch?
Yes
No
3. How many days of school have you missed this school year?
4. How many discipline referrals have you had this school year?
5. Are you the oldest child? ______ If not, what is your birth order? _____
6. How many brothers/sisters do you have? ____ sisters ____ brother
7. Has anyone attended college in your immediate family (brother, sister, mom, or dad)?
Yes - If yes, please identify
Associates
Bachelors
Some hours
No
8. Do you have a computer at home?
Yes - If yes, do you have access to the internet?
Yes
No
No
9. How many books have you read this school year?
10. Due to transportation not being provided, will an adult be able to transport you to and from school?
Yes
No

who would they be and why? Topic 2: What obstacle(s) and/or challenge(s) have you faced during your academic career and explain what expectations you have of Collegiate High School? NOTE: The student essay must be HANDWRITTEN and completed on no more than TWO pages provided. STUDENT ESSAY The student must respond to both of the following topics.Student’s Name CHS/ECHS Student Lottery Application PAGE 2 SECTION C. Topic 1: . Topic 1: If you could gather three people together for a conversation.

Topic 2: ______________________________ Student’s Signature Date .

Science. IMPORTANT:   Only ORIGINAL applications will be accepted. The forms must be returned to you in a sealed envelope and submitted with this application. APPLICATIONS RECEIVED AFTER THE DEADLINE WILL NOT BE CONSIDERED. ACADEMIC RECORDS Report card grades and student assessment data will be retrieved for review from the CCISD student management system. Box 110 . or Social Studies) of your choice. If additional information is needed. 2016. access.O. TX 78403-0110 Telephone: (361) 698-2425 Deadline: Friday. and if accepted for admission to the school. I will abide by all rules and regulations set forth by both the ECHS and Del Mar College. English. Faxed or e-mailed applications will NOT be accepted. PARENT/GUARDI AN STATEMENT Did you attend any of the scheduled Parent/Student Information Meetings? If so. SECTION F. I grant and authorize administrative officials to verify. the applicant will be contacted. APPLICATIONS MUST BE POSTMARKED OR RECEIVED IN THE OFFICE OF SCHOOL SERVICES BY THE APPLICATION DEADLINE.801 Leopard Street Corpus Christi. 2016  February 18. I am interested in attending Collegiate High School and want to be considered for enrollment. I certify that the information provided is complete and understand that the submission of false information is grounds for denial of my application and/or withdrawal of admissio n. verified. March 4.  January 28. I understand that the school and college expect a high standard of conduct for its students. 4:00 p. 2016 Why do you feel your child is ready to attend Collegiate High School at Del Mar College? SECTION E. and/or attached:  Section A  Section B  Section C  Section D  Section E _____________________________________________ _________________________ _____________________________________________ _________________________ Signature of Parent/Guardian Date Signature of Student Date MAILING ADDRESS: CORPUS CHRISTI INDEPENDENT SCHOOL DISTRICT Department of School Leadership ATTN: Collegiate High School P. Check the following sections that have been completed.m. .SECTION D. TEACHER RECOMMENDATION FORMS th Please distribute the attached Teacher Recommendation Form to two 8 grade teachers (Math. 2016  February 4. Information is to be kept CONFIDENTIAL as part of the students application. please indicate the date. and utilize academic information such as grades and assessment data to support this application.

Texas COLLEGIATE HIGH SCHOOL Teacher Recommendation Form 2016 .2017 I hereb y give you permission to complete the following reference request furnished b y Corpus Christi Independent School District and to forward the completed form to CCISD. I understand that this information will b ecome part of my application and is considered CONFIDENTIAL and will not b e revealed to me. Academic Characteristics Often Occasionally Rarely Cannot Evaluate Accepts responsibility for learning Makes decisions independent of peers Works well with peers Communicates ideas effectively Completes tasks Works independently Accepts personal responsibility for actions Accepts academic challenges Has interests beyond the classroom Shows respect for authority Social/Emotional Characteristics Strong Good Average Fair Emotional Stability Creativity Adaptability Judgment/Common Sense Maturity Patience with others Leadership Initiative/Enthusiasm Motivation Thoughtfulness Integrity/Honesty What other insights/comments do you wish to convey to the Admissions Review Committee regarding this applicant? ______________________________ _________________________ ______________________________ _________________________ Teacher’s Name (please print) Teacher’s Signature School Grade/Course Date Date Cannot Evaluate . A forthright evaluation is extremely helpful in choosing among high qualified candidates. It should be submitted in a S EALED ENVELOPE with the application. Please evaluate the student applicant by checking the appropriate column. Student’s Name: _______________________________________________________________________________________ _______ First Nam e Last Nam e School NOTE: This form is to remain CONFIDENTIAL. The student named above is applying for admission to the Early College High School located at Del Mar College.CORPUS CHRISTI INDEPENDENT SCHOOL DISTRICT DEL MAR COLLEGE Corpus Christi.