Wesleyan Pre-College Access Program

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1 Wesleyan Pre-College Access Program What is the Pre-College Access Program? Wesleyan University s Pre-College Access Program is a comprehensive program developed to enhance the academic skills and preparation of talented high school students who have an interest in pursuing higher education. While providing students with academic support, the program also provides hands-on science and math experience and exploration. The Pre-College Access Program assists students in the college preparation, identification, and application process. It also provides a six-week summer program on the campus of Wesleyan University, and an after school and Saturday Program during the academic year. Students participate until their high school graduation. What does the Pre-College Access Program offer? Summer preparation for academic year After school academic and pre-professional enrichment SAT Preparation Academic support in Math, Science, English, and other subjects College visitation program Assistance with selecting and applying to colleges Assistance in completing financial aid and scholarship applications Assistance in analyzing financial aid packages and options SAT and college application fee waivers College preparation Community Service opportunities Cultural and enrichment activities Program Criteria Demographics Students will ideally come from a low-income, first-generation college-bound, underrepresented background. At least one of these three criteria should be met. Low-income is defined by the U.S. Department of Education as an individual whose family s taxable income for the preceding year did not exceed 150 percent of the poverty level amount. First-generation is defined as neither parent has attained an Associate s Degree or higher. Underrepresented is defined as Black or African-American, Hispanic or Latino, Native American Indian, Alaskan, Hawaiian or Other Pacific Islander, or Asian/Asian American. Academic Performance Students will ideally have a minimum GPA of 2.5 (80, B-). College Ambition, Potential, and Motivation Candidates should want to go on to higher education, and have the potential and motivation to do so. Attendance, Participation, Involvement, and Transportation Candidates should want to participate in the program and attend events and meetings, including once a month on Saturdays. Participation in the summer program is strongly encouraged. Students need to have their own transportation for all on-campus activities. Transportation for offcampus activities will be provided, but students must be able to get to and from the program office. Behavior and Discipline Candidates should be mature, responsible, and self-disciplined. They should present themselves positively and always show genuine respect for themselves and others. This includes maintaining a high standard of honesty and integrity. Students should not be subject to disciplinary action in school while in the Program. Students that violate Program rules or do not meet expectations must be aware of consequences, including possible dismissal from the Program.

2 Wesleyan University Pre-College Access Program Student Application FOR OFFICE USE: Date: Accepted Income First Generation Underrepresented Disability Rejected Student's Name: Social Security Number: Student's Address: Street City State Zip Code Home Phone Number: Cell Phone Number: Address: Gender: Male Female Birth Date: / / Age: School Attending: Middletown HS WWMS Other High School Graduation Year Ethnicity (check all that apply): American Indian or Native Alaskan Asian Hispanic or Latino Native Hawaiian or Other Pacific Islander White Black or African American Student s Citizen Status U.S. Citizen or National Permanent Resident Other Does the student have a physical disability which might require an environmental accommodation or a learning disability which we should be aware of? Yes No If yes, please describe the disability: With whom does the student live? Both parents Father only Mother only Foster Parents Legal Guardians Mother/Stepfather Father/Stepmother Grandparents Other (Relation to Applicant) English- Speaking Home Yes No If no, language spoken in home: Mother/Stepmother/Guardian Full Name: Address: Street City State Zip Code Home Phone Number: Cell Phone Number: Work Phone Number: Address: Highest grade level completed: Assoc. Degree BA/BS MA/MS PhD Other Occupation: Employer: Father/Stepfather/Guardian Full Name: Address: Street City State Zip Code Home Phone Number: Cell Phone Number: Work Phone Number: Address: Highest grade level completed: Assoc. Degree BA/BS MA/MS PhD Other Occupation: Employer: 2

3 CONFIDENTIAL FINANCIAL ELIGIBILITY INFORMATION (TO BE FILLED OUT BY PARENT OR GUARDIAN WITH WHOM STUDENT RESIDES) Please answer ALL questions. This application cannot be considered if the required information is not provided. The personal information given to the Pre-College Access Program is kept on file for grant funding verification purposes. This information is protected by the Privacy Act. Only Pre-College Access/Upward Bound Math-Science staff or those who have special authorization will view this information. The requested information is necessary to determine if you are eligible to participate in the Program and assists in measuring our success. Parent(s) or Guardian(s) Name Address City State Zip Code Phone Relationship to Student: Date: Did you claim the applicant as an exemption on your most recent income tax return? Yes No Please mark your family size and taxable income on the table below: Size of Family Unit (circle the number in your family) Taxable Income (circle your most recent yearly taxable income) 1 $0 - $17,655 2 $17,656 - $23,895 3 $23,896 - $30,135 4 $30,136 - $36,375 5 $36,376 - $42,615 6 $42,616 - $48,855 7 $48,856 - $55,095 8 $55,096 - $61,335, or above You can find your taxable income on: IRS FORM Line 43 IRS FORM 1040A - Line 27 IRS FORM 1040EZ - Line 6 * If you do not file a tax return and are unsure what your taxable income is, please attach a copy of an income statement, such as: - Wage and Tax Statement(s) (W-2) - Unemployment Statement(s) (1099-G) - Social Security Income Statement(s) (SSA-1099) - Other Income Document(s) Names of Individuals Living at Home (Please attach additional sheet if needed) Age Relationship to student Total Number of Individuals Living at Home (Please include parents/guardians and siblings) I certify that the information reported on this statement is, to the best of my knowledge and belief, true, correct, and complete. Parent/Guardian Signature 3 Date

4 4 WESLEYAN UNIVERSITY PRE-COLLEGE ACCESS PROGRAM CONSENT TO RELEASE INFORMATION ON YOUR CHILD The personal information given to the Pre-College Access Program is kept on file for grant funding verification purposes. This information is protected by the Privacy Act. Only Pre-College Access/Upward Bound Math-Science staff or those who have special authorization will view this information. The requested information is necessary to determine if you are eligible to participate in the Program and assists in measuring our success. Your child is a candidate for the Wesleyan University Pre-College Access Program, which is operated in cooperation with your local school system. It is funded by Wesleyan University, community partners, and your local School Board. The Program assists eligible students in developing motivation, academic skills, and financial-aid knowledge necessary for post-secondary education. To be considered for this Program, we must have your authorization, in order to request information from middle schools, high schools, colleges, testing institutions, and other agencies or universities on behalf of our students and Program. Your signature at the bottom of this form authorizes the Prospect Math-Science Program to: Request a copy of your school and/or college transcript and test scores, Access to online school records including PowerSchool, Request a copy of your PSAT, SAT, ACT, CMT or CAPT test scores, Request information from your school about learning or other disabilities you have disclosed to us, Use your Social Security number to request a copy of your financial aid application, transcripts, college enrollment status, and awards from the federal and state funding agencies, post-secondary institutions, and the National Student Clearinghouse, Communicate with representatives from agencies or post-secondary institutions on your behalf, I hereby authorize the above-mentioned parties to provide the Wesleyan University Prospect Math-Science Program with information and records on my child. Student s Social Security Number: Print Student s Name: Student s Signature: Date: Print Parent s Name: Parent s Signature: Date:

5 5 PUBLICITY AND PHOTO RELEASE FORM The Wesleyan Pre-College Access Program is making a concentrated effort to promote the positive activities, honors, and work of our staff and students. This includes working with the local newspapers, radio, and television stations and also developing our own publications. These publications include information, likenesses, and images, which may appear on the University web site as well as in other publications. As we go about this project there will be opportunities for various students to be interviewed and/or photographed and identified by name and grade or school. However, we understand that some parents may request that we do not identify their child(ren). Please fill out the form below to inform us of your wishes regarding publicity. Please note, however, that your child s image or likeness may appear in occasional candid photos without any type of name identification and the use of these candid photos of your child is permissible. (Please print. Use a separate form for each child) Student Name Grade Parent/Guardian Name I give permission for my child to be interviewed, identified, and/or photographed/filmed for use in program publications, including, but not limited to, publication via web site or other technological publications, videos, newspapers, radio, or television. I request that you do not interview or photograph my child. Parent/Guardian Signature Date This form will be kept on file at our office. If a situation arises that may change your child s status regarding publicity, please notify us in writing as soon as possible. New photo release forms will not be required each school year.

6 6 WESLEYAN UNIVERSITY PRE-COLLEGE ACCESS PROGRAM MATH/SCIENCE TEACHER RECOMMENDATION Applicant s Name: Grade: 8 th 9 th 10 th 11 th Teacher s Name: Name of School: Name of Subject & Level: Advanced/High Honors Honors College Prep. Regular/Basic Other: This student has applied as an applicant for the Prospect Math-Science program. Please rank the student in each category below. Category Academic Self- Discipline Intellectual Promise Academic Effort Initiative Independence Creativity Maturity Motivation Leadership Potential Ability to ask for & access help Overall assessment of student relative to others in their grade Below Average Average Above Average Excellent Outstanding (5%) One of the top few encountered in my career 1. Does this student excel in your current math or science course? 2. If you could make a suggestion of how the student could improve, what would you suggest?

7 7 3. Any other information regarding the applicant would be greatly appreciated (i.e. personality, skills, participation, interaction with peers and authority figures, etc.). 4. Please check the following services/skill development that you think the applicant needs: Writing skills & Grammar Reading Skills Mathematical Skills Homework completion Study Skills (note taking, test preparation, time management, etc.) Motivation to study Motivation to pursue college Class attendance Leadership & Presentation skills Social & Communication skills Self-esteem and/or confidence 5. Does the student perform at grade level? Yes No Signature: Date:

8 8 WESLEYAN UNIVERSITY PRE-COLLEGE ACCESS PROGRAM PERSONAL STATEMENT Applicant s Name: Date: This personal statement will help us get to know you better as a person and student in ways that differ from courses, grades and test scores. It will also demonstrate your ability to organize your thoughts and express yourself. Instructions: Please write a brief essay that answers each of the following questions (you may attach additional pages if needed; you may also type answers if you prefer): What are your personal beliefs and values? What is important to you? Please write briefly about a challenging or stressful experience you have overcome. What are your strongest skills?

9 9 Are there any skill areas that you think this program can help you with? Please write about the first time you realized that differences exist between people (i.e. ethnicity, race, gender, nationality, language, etc.). What are some careers that you have thought about going into? What types of jobs would you want to do/see yourself doing? Applicant s Signature: Date:

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