HOW TO APPLY FOR THE GATEWAY TO COLLEGE PROGRAM

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1 One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ fax HOW TO APPLY FOR THE GATEWAY TO COLLEGE PROGRAM Step 1: Attend an Information Session The Information Session provides students the opportunity to show that they have the reading, writing, and math skills necessary to achieve success in a college environment. You will also have the opportunity to ask questions as they relate to the admissions process. Step 2: Complete the Application Packet Please note that some of the required information requires completion and signature by a parent or legal guardian (if the student is under 18) and authorized high school representatives. Complete all applicable sections and SIGN the application Complete all THREE essays (Essay 1 has 2 sections, Essay 2 and Essay 3) Provide an official high school transcript from all high schools attended Complete the Consent to Release Information Form Submit a completed School District Information Form Provide proof of MA medical insurance coverage Submit a completed Recommendation Form Step 3: Participate in an Evaluation Session The Evaluation Session provides students the opportunity to show that they have the reading, writing, and math skills necessary to achieve success in a college environment. Students must arrive on time for each session and will need picture identification for the Evaluation Session. Acceptable identification may include a driver s license, school ID, etc. Step 4: Participate in a Personal Interview Students who meet eligibility requirements at the Evaluation Session will be invited and scheduled for a personal interview. Staff members will use the interview as an opportunity to get to know a student better, to learn about his/her strengths, weaknesses, and concerns. Students will also be able to ask questions during the interview. Step 5: Selection Committee Review The Selection Committee will review all applications for the Gateway to College program. Acceptance to the program is not guaranteed. Space in the program is limited. The Selection Committee will evaluate applicants and materials based on the following criteria: Applicants must meet ALL eligibility requirements. Applicants must achieve at least the minimum standard score on testing. Applications, including essays, must be complete and submitted by the deadline date. Applicants must take part in a personal Interview. Applicants must express a commitment to receive a high school diploma and to complete the Gateway to College Program. Applicants must display positive attitude, appropriate behavior, and a willingness to participate. **All applicants will be notified by letter of the Selection Committee s decision. Students who are accepted into the program will be asked to confirm or decline their acceptance via mail.** 1

2 One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ fax GATEWAY TO COLLEGE APPLICATION Please read this application carefully when completing the requested information. Print or type clearly in blue or black ink. Student s Full Legal Name Telephone ( ) - Cell ( ) - Address Home Address: City State Zip Code Student s Personal Information Social Security Number - - Are you a U.S. Citizen? Yes No Date of Birth - - Age Are you a Permanent Resident? Yes No Alien Registration Number: Date Issued Date expires Birthplace (City) (State) (Country) Gender: Female Male Ethnicity: Please check one: Hispanic/Latino Not Hispanic/Latino If Not Hispanic/Latino please also check one or more of the following: White African-American Native Hawaiian or other Pacific Islander Asian American Indian/Alaska Native Do you (the student) have children Yes No If YES how many? What are the ages? Language(s) spoken at home Native Language Transportation: Note: Students are provided a free PVTA bus pass or parking decal for their car that is good for the whole year/semester. They can only choose one and are NOT able to have both or to switch at any time during the academic year. Choose a mode of transportation: PVTA Car If driving your own vehicle, you must provide the following information: Registered Owner of Car: License Plate #: Car Make: Car Model: Year: Color: Medical Insurance: Do you have Massachusetts medical insurance? Yes No If YES who is your provider? Policy Holder s Name ID Number 2

3 Contact Information Mother s Name: Father s Name: Mother s Phone: Father s Phone: Guardian Phone: Name of Parent/Guardian with whom you live If guardian, what is this person s relationship to you? Name of Emergency Contact other than parent/legal guardian Address of Emergency Contact other than parent/legal guardian City State Zip Code Telephone ( ) - Cell phone: Other Phone: Relationship to you: Academic Information What was the last grade that you attended? 6 th 7 th 8 th 9 th 10 th 11 th 12 th Which school district do you live in? Have you dropped out of school or are you thinking about dropping out? Yes No If yes please explain. If no, explain why you are interested in Gateway to College. Have you attended high school in the last 60 days? Yes No Are you currently attending school? Yes No *If yes, provide the name of your school, current grade and guidance counselor. School/ Current Grade Guidance Counselor *If no, when was your last year of attendance? Have you taken the 10 th grade MCAS? Yes No I Don t know Have you ever been on an IEP (Individualized Education Program)? Yes No I Don t know Have you ever been on a Section 504 Plan? Yes No I Don t know Have you ever been suspended or expelled/dismissed from any school or college? Yes No If you answered yes, please explain. 3

4 Employment Do you currently have a job? Yes No Employer How many hours, on the average, do you work each week? If you currently do not have a job, are you looking for one? Yes No If yes, please complete the following: How many hours, on the average, do you plan to work each week? Referral Information I learned about this program from and/or was referred by: (Please check all that apply) Family/Friend School Counselor or Administrator (name of school: ) Agency (specify: Case Manager: ) Current or Former Gateway to College Student (name of student: ) Internet Alternative School or Program (specify: ) Radio Brochure/Flyer Other (specify: ) Required Signatures I certify that the information on my application is accurate and complete. I understand that if I fail to provide accurate or complete information, including required materials such as transcripts, I may be denied acceptance to the Gateway to College Program. I also understand that even if I provide accurate and complete information that my acceptance to the Gateway to College Program is not guaranteed. I also understand that I cannot be enrolled in any other high school, alternative high school program, home school, or other college while participating in the Gateway to College Program. If selected for the Gateway to College Program, I agree to abide by the Springfield Community College s Policies, including but not limited to the Student Code of Conduct, Affirmative Action Plan, and all Gateway to College policies and procedures. Applicant Signature Parent Signature (If applicant is under the age of 18) Date Date 4

5 Three Required Essays The essay portion of the Gateway to College Application helps the selection committee to become acquainted with you on a personal level, and is one of the most important steps in determining which students will be accepted to the Gateway to College Program. The application is not complete without the three essays. DIRECTIONS: On separate sheets of paper, please respond to all essay questions. Essays should each be at least two paragraphs. Each essay can be more than 2 paragraphs, but please don t submit essays that are less than 2 paragraphs. If you do not have access to a computer or typewriter, you may neatly hand write your answers in ink on separate pages. Please write your name on each page. Attach the essays to your application. Essay 1 Section A (at least 2 paragraphs) Please tell us about your strengths. Which personal strengths help you to survive? Which strengths make you want to keep on trying, even when the going is difficult? Which strengths help you to make friends and help you to establish positive relationships with adults? Which strengths help you to say No to your peers when they attempt to distract you from reaching your educational goals? Section B (at least 2 paragraphs) Tell us about key personal problems or challenges from the past that have interfered with the completion of your education. (Examples of problems or challenges might include attitude, behavior, motivation, skills, support, need to feel accepted, cultural barriers, etc ) Essay 2 (at least 3 paragraphs) Why are you interested in becoming a part of the Gateway to College Program at Springfield Technical Community College? Why do you think that this program is a good fit for your personal goals and your life? How will the program help you to reach your goals? Since there are a limited number of slots in this program, tell us why the selection committee should choose you! Essay 3 (at least 2 paragraphs) As a full-time college student, how will you balance coursework, employment, commitments to family, and to your social and personal life? What will motivate you to attend class 100% of the time? What will motivate you to complete all of your homework each night (which may take up to 3-4 hours every day)? I certify by signing below that I wrote my own essays and they reflect my own original thoughts, words, and writing skills. Applicant s Signature: Date: 5

6 One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ fax CONSENT FOR STCC TO RELEASE INFORMATION Springfield Technical Community College shall follow all applicable state and federal laws, rules, and regulations that apply to the confidentiality of student records. All information contained in student records shall be maintained in compliance with the Family Educational Rights and Privacy Act (FERPA). I hereby authorize my school district to release information to STCC and for STCC to release information to my school district. I authorize STCC to release information to the Gateway to College National Network for the purpose of studying program and instruction improvement. I, (Last Name of Student) (First Name) (Middle Initial) (Date of Birth) (SSN) hereby authorize STCC to release the information listed below, from my STCC student record, for the duration of my enrollment in the Gateway to College Program to: 1. (Name of Person or Agency) (Relationship to Student) (Phone Number) 2. (Name of Person or Agency) (Relationship to Student) (Phone Number) 3. (Name of Person or Agency) (Relationship to Student) (Phone Number) Below, find examples of the type of information that will be released through authorization of the applicant: *Name, Address, Phone *Date of Birth *Name of Most Recent High School and Dates Attended *Disciplinary Record *Health Record *Transcript of Grades/Courses/Schedule *Verification of Attendance *Test Scores and Record of Progress *Date of Graduation and Name of Program *Counseling Student Signature Parent/Guardian Signature Date Date 6

7 One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ fax SCHOOL DISTRICT INFORMATION RELEASE FORM This form is being given to you by a student who is applying for the Gateway to College Program. In order to assess whether Springfield Technical Community College is able to meet the applicant s educational needs, we are requesting an documents, where applicable. Applicants, after meeting minimum eligibility requirements, who have received educational support via an IEP or 504 Plan will be asked to approve of a meeting, which will be scheduled with appropriate personnel from their sending school district and an STCC Gateway staff member in order to determine whether the Gateway to College Program is an appropriate placement for the applicant. Student Information: Name: Home Address: Home Phone: Date: Zip Code: Cell Phone: Through these signatures we grant permission to release the student s high school records, including but not limited to official transcripts, MCAS scores, official withdrawal letter, IEP, 504 Plan, and SASID Identification Number as applicable, for the applicant named above: Student Signature: Parent/Guardian Signature: Date: Date: To the school official: Please check off all documents which are being forwarded from the sending school district to STCC AND complete contact information below: An official high school transcript. The student s IEP/504 or The student does not have an IEP/504 MCAS scores for 9 th grade Science and/or 10 th grade ELA, Math and Science. An official withdrawal letter if applicable. Student Identification Number. School Official Contact Information Name of School: Name of School Official (Please print or type): Title of School Official: Signature of School Official: Telephone Number of School Official: ( ) - 7

8 One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ fax Request to Transfer Enrollment Status Upon acceptance to the Gateway to College program I,, request that the active (Parent/Guardian Name) enrollment status of,, be transferred from a Springfield (Student Name) Public School to Gateway to College. By signing below, I acknowledge that acceptance to the Gateway to College program is not guaranteed. I understand that IF accepted, then and only then will the active enrollment status of my child be transferred to Gateway to College. Parent/Legal Guardian Signature Date Home Address City State Zip Code Home Phone Number Cell Phone Number Student Signature Date FOR GATEWAY TO COLLEGE STAFF USE ONLY Student s expected start-date/semester/year at Gateway to College: Gateway to College Staff Member Name Date Comments: 8

9 Student/Legal Guardian Notification & Acknowledgement Springfield Technical Community College (STCC) strives to provide quality instruction and support for all students attending post-secondary classes on the campus. Students who are conditionally admitted are granted the same rights and have the same responsibilities as any other college student. Therefore, it is required that each student and, if applicable, her/his guardian review the information listed below and sign the acknowledgement indicating that they understand and accept responsibility for the decision to enroll. 1. I understand that Springfield Technical Community College is a public community college campus that is accessible to the Springfield community. 2. I understand that if I choose to enroll in Gateway to College and then subsequently withdraw, I may not be able to re-enroll at my sending SPS high school. 3. I understand that there could be classroom discussion or materials that the student/parent may not consider age appropriate for a minor student. If the student or parent is not comfortable with an assignment or classroom discussion, the faculty member is not required to substitute an alternate activity or grading exercise. 4. I understand that the grade received by the student is part of the student s permanent post-secondary academic record and may affect the student s eligibility for college scholarships or freshman/first-time status at other institutions of higher education. 5. I understand that while the student will have equal access to any academic support services offered to the student body, no extraordinary academic measures will be granted the student due to minority (age). 6. I understand that the student s academic record (grades, attendance, and progress in class) cannot be accessed by the parent or guardian without a written release signed by the student. 7. I understand that the faculty member will provide information and updates on a student s academic progress directly to the student. 8. I understand that the student is expected to comply with all of the policies of STCC and the Gateway to College Program, including but not limited to the Code of Conduct and Affirmative Action Plan. Violations of these policies may result in disciplinary action up to, and including, dismissal from the Gateway to College Program and/or the College. I have reviewed the information listed above. I acknowledge the responsibilities and limitations as outlined. Other: I authorize the use of any photographs or video of me and/or my quotes to be used for the purpose of promotion and marketing of the Gateway to College Program. Yes No Student Signature Printed Name Date Parent Signature Printed Name Date 9

10 Gateway to College, One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ FAX: GATEWAY TO COLLEGE CONSENT AND RELEASE FORM Student s Name: Student ID #: Date of Birth: Telephone: I (PRINT NAME) as the student named above or the parent or guardian of the student named above, hereby give my consent to Springfield Technical Community College to provide medical treatment for minor injuries, to dispense over the counter medications if needed, to provide counseling services, and to arrange for emergency transportation to the hospital as deemed appropriate by college professionals. Parent/Guardian Signature: Date: Student Signature: Date: For matters involving counseling services, I grant the counseling center permission to discuss my attendance in counseling as well as general counseling information with staff members from the Gateway to College Program. I understand that I am in control of what information is to be released and am able to revoke this consent at any time by informing, in writing, the counseling center and Gateway to College staff members. Please check one: YES, I agree to release counseling information to Gateway to College staff members. NO, I do not agree to release any information at this time. 10

11 Gateway to College, One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ FAX: Attendance Policy One of the goals of the Gateway to College program is to help students have a successful educational experience. In order to do this, regular daily attendance is necessary. We do not want irregular attendance to interfere with your educational progress and success or endanger your opportunity to continue to be in the Gateway to College program. Therefore the following policy will be enforced: Fall/Spring (full semesters): After 1 absence in a class, mandatory meeting scheduled with Academic Counselor (Success Contract may be put in place). After 2 absences in a class, mandatory meeting scheduled with Academic Counselor and/or Program Director (Academic Plan/Success Contract put in place). After 3 absences in a class, a final meeting which may result in failing/being withdrawn from that class and/or may result in program dismissal. (Probation period in place) After 3 absences in PE/Gym, students will not receive PE/Gym credit for that course. Please note: Exceeding the maximum allowable absences in one or more classes in the same semester is grounds for termination from the program One failed course may result in students taking a reduced course load the following semester, extending potential graduation date One failed course may result in termination from the program Signing this contract means that I have read and understand the document I signed. Parent/Guardian Signature Date Student Signature Date 11

12 Gateway to College, One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ FAX: GTC Scholarship Agreement Welcome to Gateway to College and congratulations on your acceptance/continuation in our program! Gateway to College and your school district have chosen to invest in you as a student, and as such, we are investing not only in you earning your high school diploma, but in you creating significant change in your life. We know that if you are successful, you will change your life for the better. You will know how to be a successful college student, future employee, and positive member of your community. We are excited to support you in this change! As a GTC student, you are expected to uphold expectations throughout your time in the program. Students in the GTC program are most successful when two components are present: 1. High level of support 2. High level of accountability Thus, GTC is requesting that you and your parent/guardian look over this Scholarship Agreement and sign each section before continuing this semester. This agreement outlines the GtC expectations, reviews what students earn in return for meeting these expectations, and outlines consequences for NOT meeting these expectations. 1. We ask your parent/guardian/support person to sign as a gesture that they will help support and encourage you. 2. We ask that you sign and acknowledge your commitment to the upcoming semester. We are here to help, and want you to succeed. Please read carefully and sign the SECTIONS below. This contract will apply to your time in the program. SECTION 1: The Expectations I agree to uphold As a Gateway to College student, I understand that I am expected to uphold certain expectations, and I agree to work with the GtC staff, instructors, and fellow students to maintain these expectations throughout the semester: 1. COMPLETION OF 15 week semester 2. Maintain 90% attendance or higher and communicate absences with GtC staff and instructors before absence 3. Earn C s or better in all of my classes/earn a 2.0 or higher 4. Improve college readiness skills listed below. Please know that we do not expect you to do all of these things right away, but we do expect you to be working and improving upon them throughout the semester. a. Attend all program meetings, workshops, mandatory events, etc. b. Complete my work and turn it in on time c. Get tutoring or attend office hours of my instructor when I am asked or when I am in need d. Demonstrate mature behavior not disrupting learning environment, adhering to norms in the classroom, coming prepared to class and arriving on time 5. Communicate with Academic Counselor and attend scheduled meetings 12

13 6. Completion of all courses registered to take unless GtC staff have approved withdrawal 7. Pay all required student fees 8. Sign in and out in GtC office each day I am on campus 9. Allow GtC staff to work with and communicate with at least one support person or parent/guardian 10. Attend both the GtC STCC and SPS graduation ceremonies at your time of graduation As a Gateway to College student, I agree to uphold the above outlined expectations for the duration of my participation in the program. Student: Date: As a parent/guardian/support person, I agree to support and encourage my student to meet the above outlined expectations. Parent/Support person: Date: SECTION 2: If I uphold the expectations in SECTION 1, this is what I can expect from the program in return As a program, GtC rewards students that take the expectations seriously and at least TRY to meet the expectations for the entire 15 week semester. As such, the GtC program also agrees to meet certain expectations. Here is what GtC offers in return for your efforts. You will: 1. Earn your scholarship for the following semester, to include approximately: a. Tuition/fees paid by Gateway to College and your school district b. books paid by Gateway to College and your school district 2. Earn the opportunity to earn your high school diploma and college credits towards a college certificate/degree a. NOTE: Not ALL classes at STCC will earn you college credit toward a college degree, but all classes will earn you high school credit b. Developmental Education classes even though they may not earn you college credit toward your college degree, they are considered prerequisites to get to the college level courses, and are ALWAYS helping you earn college credits in the future. Plus, they do earn you high school credit 3. College Environment you will be immersed in to an adult college environment where you are responsible for your education, and treated with respect. Once out in the college, your instructors will treat you as regular college students and will not discipline you like they do in high school. Expectations are more rigorous and fewer chances to misbehave will be given before you are dismissed from the class and/or the GtC program. 4. Gateway to College staff you will have your own Academic Counselor dedicated to your success, as well as the rest of the GTC team to support, encourage, and help you succeed. Your Academic Counselor is available to you most hours of most days, and is solely focused on student success. If you have the desire to succeed, we have the support and resources to help you do that. 5. College campus resources you will have access to great resources such as free individual or group tutoring, math center, writing center, one on one time with instructors, the library, free college advisors and financial aid advisors, student life activities, and much more. You are a college student when you are in the GtC program, and you have access to all the college resources. As a student, I understand the support and services I receive in return for upholding the GTC expectations outlined in SECTION 1. Student signature: Date: 13

14 As a parent/guardian/support person, I understand the support and services my student receives in return for upholding the GTC expectations outlined in SECTION 1. Parent/Support person Date: SECTION 3: If I do not abide by the GTC expectations 1. If you do NOT complete the 15 week semester with all of your required credits, follow the guidelines set forth in section 1 and below, and follow through with accessing the support your Academic Counselor asks of you, you may be immediately removed from the program or removed at the end of the semester. Below are actions that may prompt immediate removal from the program or removal at the end of the semester: a. You do not show for school/meetings AND do not communicate your absences for three or more days b. Go below 90% attendance c. Refuse services you choose not follow through with requests for support including going to meetings with instructors or GTC staff members, getting individual or group tutors, attendance at office hours d. Disrupt learning environment in class or on campus 2. If you do not meet attendance and grade requirements you: a. May be immediately removed from the program or removed at the end of the semester and referred back to the school district or to another educational option b. Be placed on a probationary term and given more support and accountability to succeed (tutors, mandatory office hours, communication with families, etc.) c. The GtC staff may call your parent/guardian to discuss situation and create a plan for success 3. If you do not return all books and pay any owed fees you: a. Will not be able to register for classes in the future b. May not be given books for the current semester c. Could be sent to collections d. Your Academic Counselor will call your parent/guardian to discuss situation and create a plan for success As a student, I understand the consequences of not abiding by the GTC expectations surrounding completion of the semester, attendance and grades, books and fees, and GTC required paperwork. Student: Date: As a parent/support person, I understand the consequences for my student not abiding by the GTC expectations surrounding completion of the semester, attendance and grades, books and fees, and GTC required paperwork. Parent/support: Date: 14

15 Gateway to College, One Armory Square, Suite 1, PO Box 9000, Springfield, MA ~ ~ FAX: RECOMMENDATION FORM A Recommendation Form is required of all applicants. Applicants should request their recommendation from a guidance counselor, teacher, employer, mentor or someone from the community that knows the applicant s abilities both socially and academically. Recommendations WILL NOT be accepted from a parent, sibling or other family member. Applicants should consider obtaining a recommendation from an adult who is willing to support the applicant in their educational endeavors. Student s Information To be completed by student. Please fill in your name and address below, date and sign, and give this form to an adult individual whom you have chosen to write on your behalf, who is not a family member. The recommender should complete this form and return it to you in a signed and sealed envelope or they can mail it directly to Gateway to College.. Name of Applicant: Address: Applicant s Waiver of Right of Access to Confidential Statement I hereby freely and voluntarily waive my right of access to any information contained in this recommendation form and agree that the statement shall remain confidential. Signature Date To the Recommender The above-named student is applying for admission into the Gateway to College program and has given your name as a reference. The information you are providing concerning the above-named applicant is an important part of the application process. We appreciate your time and thoughtfulness in furnishing this information. Please be advised that the Gateway to College Program cannot guarantee the confidentiality of your statement unless the applicant has signed the waiver printed above. Gateway to College Program Description: The Gateway to College Program at STCC is for year olds interested in returning to school and completing their high school diploma. While earning their high school diploma, students earn credits toward a college degree. This is a scholarship program. We pay the tuition and book costs for those who are accepted into the program. 15

16 Instructions: After completing this form, please place it in an envelope. Seal the envelope and sign across the seal. You may return this recommendation to the above-named applicant or mail it directly to the Gateway to College Program at Springfield Technical Community College (address is available at the top of this form). If you mail the form, please call our office to let us know and please inform the student as well. To the Recommender Name of Recommender: Title: Business: Business Address: Telephone: Business Address: 1. How long have you known the applicant and in what capacity? 2. What characteristics or attributes best describe the applicant? 3. In what area is the applicant most exceptional? 4. In what area does the applicant need the most improvement? 16

17 To the Recommender 5. Do you think this applicant has sufficient maturity and integrity to participant in an early college program? Explain. 6. Are there known problems in this applicant s background or relationships that are likely to influence collegiate performance? 7. In terms of qualities listed below, please give us your appraisal of the applicant: Judgment Above Average Average Below Average Unable to Assess Maturity Motivation Integrity Oral Communication Written Communication Ability to work with others Respect for authority 8. Overall rating: Recommend Recommend with reservations Do not recommend 9. Additional Comments: 17

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