THE CAMBRIDGE PROGRAM POTOMAC SENIOR HIGH SCHOOL CENTER FOR MATH AND PHYSICAL SCIENCES

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1 CENTER FOR MATH AND PHYSICAL SCIENCES Application Checklist : Student s Name: (print) 1. Complete the two-page application form and make sure that the student and parent/guardian both sign and date the form 2. Read the VHSL eligibility regulation and make sure that the student and parent/guardian both sign and date the form 3. Make a copy of the student s first semester (or most recent) report card. 4. Give a copy of the teacher recommendation form to TWO of the student s current teachers (math, science or language arts teachers). Have the teachers complete the form and return it to the Cambridge Program Coordinator at Potomac Senior High School by February 15. If materials are mailed, they must be postmarked by February 15. Complete items 5 & 6 if Potomac Senior High School is NOT the base school. 5. If Potomac Senior High School is NOT the base school for the student, complete the top half of a transfer request form (not included in this packet, available at any PWCS school). Do NOT take the Transfer Request Form to the base high school for the principal s signature. Potomac will forward the form to the appropriate base school. 6. If Potomac Senior High School is NOT the base school for the student, complete the Express Bus Form information. The listed bus stops are tentative. Please choose the most convenient bus stop for your student. 7. Mail or deliver the application form, VHSL eligibility form, copy of the report card, and Transfer Request and Bus Forms (when applicable) to: Ms. Courtney Wilkerson Cambridge Coordinator Potomac Senior High School 3401 Panther Pride Drive Dumfries, VA ALL PORTIONS OF THE APPLICATION MUST ARRIVE AT POTOMAC SENIOR HIGH SCHOOL OR BE POSTMARKED BY FEBRUARY 16. An incomplete application packet may prevent a student from being considered for participation in the Cambridge Program.

2 Ms. Courtney Wilkerson Website: Cambridge Coordinator Panther Pride Drive Telephone (703) Dumfries, VA Fax (703) Website: STUDENT APPLICATION FORM To be eligible for the Cambridge Program, students must have a recommendation from a Language Arts, Mathematics, or Science teacher and a B or better for the first semester in prerequisite courses. Date Grade (next year) Student s Name DOB Male Female Address City State Zip Code Home Telephone Address Name of Parent(s) or Guardian(s) (please print) Father s Work No. Mother s Work No. Name of Current Middle/High School Student ID # Will your son or daughter require any special services while attending Potomac Sr. H.S.? YES NO Name of Base High School List all specialty programs to which you have applied (including this one) in order of preference. Put a #1 by your first choice, a #2 by your second choice, etc. If you meet the qualifications for your first choice, you will be accepted into that program only. If you are not accepted into your first choice, you will be considered for your second choice, etc. If applying to more than one program, the order of preference needs to be the same on each application. You will receive only one letter of acceptance to a specialty program, which will be mailed in March. Cambridge Program Center for Math and Sciences Potomac Senior High School Center for Environmental Science (CENS) Program Freedom High School Center for the Fine and Performing Arts Woodbridge Senior High School Project Lead the Way Woodbridge Senior High School Center for International Studies and Languages (CISL) Program C.D. Hylton High School International Baccalaureate (IB) Program Gar-Field High School Information Technology (IT) Program Forest Park High School The Biotechnology Center-Osbourn Park High School

3 Student Application Form: Anticipated Areas of Study Student s Name: (print) Choose one: *AICE Diploma Program *Cambridge Certificate Program The AICE Diploma Program is designed for those students interested in a comprehensive program with an accelerated, international curriculum. They must take external examinations in six AICE level courses by the end of their senior year. These students anticipate fulfilling all the requirements for the AICE Diploma upon graduating. The Cambridge Certificate Program is designed for those students interested in taking at least one Cambridge course each year. They may take the external examinations in the Cambridge courses at the end of each year and earn certificates of achievement. *This choice may be changed at any time throughout the student s four years of high school. Program Requirements: Enrollment Contract 1. Cambridge students are required to take at least one Cambridge course in a sequence each year. 2. Cambridge students are expected to have high academic expectations, be selfmotivated, and have good study habits. 3. Cambridge students must demonstrate a commitment to succeed in this rigorous program. We, the undersigned, understand the expectations and requirements for the Cambridge Program. We request that all data in support of this student s application for the Cambridge Program be sent to the Cambridge Coordinator at Potomac Senior High School. Parent/Guardian Signature Date Student Signature Date

4 Student s Name (print) Regulation Virginia High School League Eligibility Specialty School Transfer Regulation Rising ninth grade students who transfer to a school to participate in a specialty program will be eligible for VHSL sponsored activities for athletic/activity participation. The transfer must occur at the beginning of the program. The student must meet full participation requirements of the program to retain eligibility. Rising tenth and eleventh grade students who transfer to any specialty program who wish to participate in VHSL activities MUST submit in writing a written request for eligibility with their application. If a student withdraws or is dismissed by the program director from the specialty program, once the withdrawal procedure is completed, the student must return to his/her base school. If a student withdraws from the specialty program on or before October 15, the student will be ineligible for participation in VHSL sponsored activities for the remainder of the first semester, but eligible for participation for the second semester. If a student withdraws from the specialty program after October 15, but before the end of the first semester, the students will be ineligible for participation for the remainder of that school year. Eligibility will be restored at the base school at the beginning of the fall season of the next school year. If the student withdraws during the second semester of a school year, the student will be ineligible for the next fall semester. If a student withdraws from the specialty program after one school year, the student will return to his/her base school and will be ineligible for one year. Parent/Student Commitment: We have read the above information and understand that enrollment in this program entails compliance with VHSL regulations as it pertains to athletic/activity participation. Parent/Guardian Signature Date Student Signature Date The Prince William County Public School Division does not discriminate in employment or in its educational program and activities against qualified individuals with disabilities, nor on the basis of age, gender, race, color, religion or national origin.

5 Teacher Recommendation Form Teachers: Please complete the information requested below. Return this form to the Cambridge Coordinator at Potomac Senior High School, 3401 Panther Pride Drive, Dumfries, VA by February 15. Student s Name Current Middle/High School Print: Signature: Choose one: Teacher Teacher Language Arts/English teacher (Grade Level: ) Mathematics teacher (Course name: ) Science teacher (Course name: ) Student s first semester grade Evaluation: Category Top 5% Above Average Average Below Average No Basis for Judgment Academic Ability Motivation/Self- Discipline Self-Confidence Ability to Work with Others Leadership Respect for Classmates Respect for Faculty Comments: Recommendation: (Choose one) Strongly Recommend Recommend Not Recommend

6 Teacher Recommendation Form Teachers: Please complete the information requested below. Return this form to the Cambridge Coordinator at Potomac Senior High School, 3401 Panther Pride Drive, Dumfries, VA by February 15. Student s Name Current Middle/High School Print: Signature: Choose one: Teacher Teacher Language Arts/English teacher (Grade Level: ) Mathematics teacher (Course name: ) Science teacher (Course name: ) Student s first semester grade Evaluation: Category Top 5% Above Average Average Below Average No Basis for Judgment Academic Ability Motivation/Self- Discipline Self-Confidence Ability to Work with Others Leadership Respect for Classmates Respect for Faculty Comments: Recommendation: (Choose one) Strongly Recommend Recommend Not Recommend

7 Escoja uno de los siguientes programas: THE CAMBRIDGE PROGRAM AREAS DE ESTUDIO DISPONIBLE *Diploma del programa AICE Certificado del programa Cambridge Diploma del programa AICE: está diseñado para los estudiantes interesados en un programa comprensivo con un currículo internacional acelarado. Los estudiantes deben tomar seis examenes del programa AICE en las asignutaras ofrecidas antes de terminar su último año en la escuela secundaria. Para obtener el diploma del programa AICE los estudiantes deben completar todos los requisitos del programa AICE (seis cursos) y aprobar los examenes del mismo. Certificado del programa Cambridge: está diseñado para los estudiantes interesados en tomar uno o más cursos de este programa cada año. Los estudiantes pueden tomar examenes del programa Cambridge al final de cada año y obtener un certificado indicando que aprobó exitoso el examen. * Estas opciones se pueden cambiar en cualquier momento del año, durante los cuatro años que el estudiante esté en la escuela secundaria. Contrato de Matrícula Requisitos del Programa 1. Los estudiantes inscritos en el programa de Cambridge tienen que tomar aunque sea un curso de este programa cada año. 2. Los estudiantes inscritos en el programa de Cambridge deben mantener un alto índice académico, tener iniciativa y buenos hábitos de estudio. 3. Los estudiantes inscritos en el programa de Cambridge deben mantener su compromiso de estudio para tener éxito en este riguroso programa. Nosotros, los firmantes, entendemos las expectativas y requisitos del programa de Cambridge. Solicitamos que toda la información en la aplicación del programa de Cambridge de mi acudido(a), se le envie al coordinador(a) del programa de Cambridge a Potomac Senior High School. Padres/Acudiente Fecha Firma del estudiante Fecha

8 PRINCE WILLIAM COUNTY PUBLIC SCHOOLS OFFICE OF TRANSPORTATION SERVICES SPECIALTY PROGRAM TRANSPORTATION INFORMATION FORM The Office of Transportation Services mission is to provide safe and on-time transportation for Prince William County students. In order to provide this service for the specialty programs, please complete the following information. Accurate and complete student information will assist the Bus Operations Section in allocating drivers, buses and establishing express bus stops for all eligible specialty program students before the school year begins. Express bus stop service differs from regular neighborhood service in that the parents have full responsibility to provide transportation to and from the express bus stops. Express buses stop at express bus stops only. Students living within the boundaries of the school where the specialty program is located may ride their regular bus to school. Student s Name: Address: (Include street, road, boulevard, circle, court, place, way, loop, drive, avenue, etc) Specialty Program/School: A. M. Express Bus Stop Name & Number: (See available Express Bus Stops) P. M. Express Bus Stop Name & Number: (See available Express Bus Stops) If your child does not require express bus transportation, please check the box. If the same budget constraints exist in the School Year as did in , express bus stops will be established only at express stops where six or more students have selected the stop. If fewer than six students select the stop you choose, you will be notified and asked to choose another express stop. Once an express stop is established, it will remain in effect for the entire school year unless there are no students. If you have any questions or concerns related to specialty program transportation, please contact Mary Hayes ( ) or Joyce Arrington ( ). This form must be completed and returned with the Specialty Program Application to the Specialty Program Coordinator. Parent s Signature Date

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