2014 2016 STANLEY Z. KOPLIK CERTIFICATE OF MASTERY WITH DISTINCTION APPLICATION



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2014 2016 STANLEY Z. KOPLIK CERTIFICATE OF MASTERY WITH DISTINCTION APPLICATION Deadline: May 1, 2016* The purposes of the Certificate of Mastery are to: Recognize high academic achievement on MCAS and other measures of academic achievement; Recognize high academic achievement as identified by outside forums including competitions, student publications, and awards; Provide an incentive for students to perform to their best abilities on MCAS and on the course of studies beyond grade 10; and Recognize high academic achievement in areas not included in MCAS. Who is Eligible? To be eligible to apply for a Stanley Z. Koplik Certificate of Mastery Award, a student must: Must be currently enrolled in a Massachusetts public high school. (Students who have graduated high school are not eligible to apply) Be a permanent Massachusetts resident. Be a United States citizen or eligible noncitizen. (In order to use the tuition waiver portion of the Certificate, students must be eligible to file the Free Application for Federal Student Aid (FAFSA)) Award Amounts: Recipients of the Stanley Z. Koplik Certificate of Mastery with Distinction are eligible for an award of a non-need-based tuition waiver for state-supported undergraduate courses. Individual student awards shall be no more than the resident undergraduate tuition rate at the participating institution. For updated information on current tuition rates at Massachusetts Public Colleges and Universities, please visit: http://www.mass.edu/campuses/tuitionfees.asp The tuition waiver must be used in the September following high school graduation and is valid for eight (8) consecutive semesters provided the student maintains a G.P.A. of 3.3 for continued eligibility. If the G.P.A. falls below the 3.3 then the student loses the waiver. Students MUST file the Free Application for Federal Student Aid (FAFSA) in order to use the tuition waiver portion of the Certificate. * Students taking AP exams or SAT subject tests after this date must still file an application by this deadline. Please see Section II for more information on the submission process. Students may not file an application after graduating from high school. Koplik Certificate of Mastery with Distinction Page 1 of 6

Requirements for the Stanley Z. Koplik Certificate of Mastery with Distinction SECTION I: Initial Requirements: To initially qualify, a student must score Advanced on one Grade 10 MCAS assessment (either in Mathematics, English Language Arts, or Science) and either Advanced or Proficient on the other two. Students who have met this requirement will receive an eligibility letter from their high school during their junior year. SECTION II: Application: Students must complete and submit the application for the Koplik Certificate of Mastery with Distinction by May 1 st of their senior year in high school. The application must be submitted to the high school s Koplik Coordinator or guidance counselor for proper review, certification and submission to the ESE. Applications sent directly to the ESE will be returned to the high school for proper processing. Students scheduled to take SAT subject tests and/or AP exams in May or June must still submit the application to their schools Koplik coordinator on or before the May 1 st deadline. AP Exam and some SAT Subject Test scores arrive at your high school in the summer. Your Koplik Coordinator will notify the ESE when all of your scores and other documentation have been received and approved (indicated by the Koplik coordinator s signature on the application). Successful applicants will receive the Certificate of Mastery with Distinction from the Massachusetts Department of Elementary & Secondary Education. You MAY NOT make an initial application after you have graduated from high school. SECTION III: Standardized Test Requirement (per Massachusetts 603 CMR 31.05(2)): Students have the choice of ONE of the following options: a. two Advanced Placement exams with scores of 3 or better, or b. two SAT Subject Tests (subjects and minimum required scores listed below), or c. one SAT Subject Test and one Advanced Placement exam, or d. one of the above mentioned tests/exams and one Other Academic Achievement (see below for options and next page for examples). Please note (per Massachusetts 603 CMR 31.05(3)): Test scores (in any combination) and /or academic achievements MAY NOT be in the same content area. For example: i. If a student passes an exam in any area of Biology then (s)he may not submit scores from any other science exam (i.e. Chemistry, Physics, Earth Science, etc.) or academic achievement. ii. If a student passes an exam in any area of Social Studies then (s)he may not submit scores from any other History/Social Studies exam (i.e. Microeconomics, World History, etc.) or academic achievement. iii. If a student passes an exam in any area of Math then (s)he may not submit scores from any other Math exam (i.e. Calculus, Statistics, etc.) or academic achievement. iv. If a student passes an exam in any area of English/Language Arts (ELA) then (s)he may not submit scores from any other ELA exam (i.e. Literature, English Language and Composition, etc.) or academic achievement. v. If a student passes an exam in a foreign language then (s)he may not submit scores from any other foreign language exam or academic achievement in the same language area (i.e. German and German Language & Culture, etc.). Koplik Certificate of Mastery with Distinction Page 2 of 6

Acceptable Standardized Tests and Minimum Scores: SAT Subject Tests - Minimum test score in parenthesis Qualifying SAT Humanities (Foreign Language) Subject Test Scores Chinese with Listening (700) French (649) French with Listening (625) German (561) German with Listening (586) Italian (650) Japanese with Listening (650) Korean with Listening (700) Latin (628) Modern Hebrew (630) Spanish (589) Spanish with Listening (572) *Students may not submit scores for tests taken in the SAME foreign language area Qualifying SAT Humanities* (Social Studies) Subject Test Scores U.S. History (608) World History (600) *Only ONE History/Social Studies test score / academic achievement will be accepted Qualifying SAT Humanities* (ELA) Subject Test Scores Literature (612) *Only ONE ELA test score / academic Qualifying SAT Math* Subject Test Scores Mathematics Level 1 (640) Mathematics Level 2 (639) *Only ONE Math test score / academic Qualifying SAT Science* Subject Test Scores Biology (600) Chemistry (646) Biology (Ecological) (600) Biology (Molecular) (600) Physics (618) *Only ONE science test score / academic English Lang. & Composition English Lit. & Composition *Only ONE ELA test score / academic Advanced Placement Exams All Scores must be a 3 or better English* Science* Social Studies* Biology Chemistry Environmental Science Physics B Physics C: Electricity & Magnetism Mathematics* Physics C: Mechanics *Only ONE science test score / academic Calculus AB Calculus BC Statistics *Only ONE Math test score / academic Computer Science A Psychology Music Theory Other Music Foreign Language* Chinese Lang. & Culture French Lang. & Culture German Lang. & Culture Italian Lang. & Culture Japanese Lang. & Culture Latin Spanish Lang. & Culture Spanish Lit. & Culture *Students may not submit scores for tests taken in the SAME foreign language area European History Gov t & Politics: Comparative Gov t & Politics: US Human Geography Macroeconomics Microeconomics US History World History *Only ONE History/Social Studies test score / academic achievement will be accepted Arts* Art History Studio Art: 2-D Design Studio Art: 3-D Design Studio Art: Drawing *Only ONE Art test score / academic Koplik Certificate of Mastery with Distinction Page 3 of 6

SECTION IV: Other Academic Achievements (option d above): Students may substitute evidence of another academic achievement from their high school years for ONE passing score on any of the tests listed above. 1. College Courses: A student must receive a grade of B or higher on a college course taken during high school. Documentation is an official transcript from a college or university. This course may not be in the same content area as the standardized test score submitted. 2. International Baccalaureate Program: Students must complete the IB Diploma Programme (DP) and be awarded either a full Diploma or a Bilingual Diploma during or upon graduating from high school. Students who are awarded a Certificate through the IB Programme must receive a score of a 5 or better during or upon graduating from high school. Documentation is an official transcript from the International Baccalaureate Program. 3. Competitions, Prizes, Awards, Publications: A student must win a prize or award in a competition or be selected for an activity or publication, beyond the local school level, based on excellence in achievement in an academic or artistic field. Evidence could be a certificate, award, article or excerpt and title page from a publication, or a letter from a sponsoring organization indicating the level of work the student accomplished. This achievement may not be in the same content area as the standardized test score submitted. Please note that the following programs/achievements DO NOT meet the criteria for the Koplik Certificate of Mastery with Distinction (Please note that this is not intended to be an exclusive list): a) Eagle Scouts b) MA Student Trooper Program c) National Honor Society (General membership) d) National Society of High School Scholars (General Membership) Koplik Certificate of Mastery with Distinction Page 4 of 6

Below are examples of competitions, prizes, awards, and publications that may be used to substitute for one of the two required exams. Please note that this is not intended to be an exclusive list. A qualifying academic achievement MUST have a direct connection to the standards of the Massachusetts Curriculum Frameworks, which can be found at: http://www.doe.mass.edu/frameworks/current.html. Examples: Academic Decathlon Competition Alzheimer s Association Leadership awards American Invitational Mathematics Exam (AIME) American Field Service Scholarship Massachusetts Art Education Association: Art-All State Boys State and Girls State Business Professionals of America (BPA) Skills Development Award Destination Imagination----either Massachusetts or National Recognition Distributive Education Clubs of America (DECA) Skills Development Award English-Speaking Union's National Shakespeare Competition Family, Career, and Community Leaders of America (FCCLA) Skills Development Award FIRST (For Inspiration and Recognition of Science and Technology) Award Ford/AAA Automotive Technology Skills Development Award Future Business Leaders of America (FBLA) Skills Development Award Future Farmers of America (FFA) Skills Development Award Greater Boston Youth Symphony participation High Schools That Work Award of Educational Achievement Scholastic Art and Writing Awards, Massachusetts and National International Mathematical Olympiad (IMO) Intel Science Talent Search semi-finalist or finalist Junior Engineering Technical Society (JETS) Competition state finalist Junior Achievement Award winners Latin Certamen Competition gold or silver medalist Massachusetts Foreign Language Association (MAFLA) Essay Contest Massachusetts Foreign Language Association (MAFLA) Past President's Award Massachusetts Business Education Association Award for Exemplary Achievement Massachusetts or National History Day prizes for written papers, audio/visual presentations Massachusetts Theater Guild competition finalist Microsoft Certification Programs Computer Science Massachusetts Music Educators Association: Music All State National Arts Talent Search National French Honor Society (or other SPECIFIC Honor Societies general NHS does not qualify) National Language Exams semi-finalist or finalist National Merit Finalist National Society of High School Scholars Academic Paper Awards (or other SPECIFIC awards general NSHSS does not qualify) Publication in a literary magazine such as The Concord Review Science Competitions, i.e., Science Olympiad individual honor award Skills USA Skills Development Award Regional Talent Search/Johns Hopkins University State Recognition Shakespeare Competition State finalist for outstanding performance USAMO-USA Mathematical Olympiad We the People Competitions of the Center for Civic Education Koplik Certificate of Mastery with Distinction Page 5 of 6

Massachusetts Department of Elementary and Secondary Education 75 Pleasant Street, Malden, Massachusetts 02148-4906 Telephone: (781) 338-3000 TTY: N.E.T. Relay 1-800-439-2370 Student information: Koplik Certificate of Mastery with Distinction Application Name: D.O.B.: / / SASID#: School/District: Graduation Year: 20 Email Home Address: City: Zip: Three qualifying MCAS scores: Please attach a photocopy of your Tenth Grade MCAS student score report. One score must be at the Advanced level and the other two scores either at the Advanced or Proficient level. (a) English Language Arts (b) Mathematics (c) Science Two additional academic achievements*: At least one academic achievement must be a passing score or above on a standardized test. Please refer to Section III in the application packet regarding which standardized tests are acceptable and in what combinations. In addition, please note that two scores (in any test combination) in the same content area, (for example: SAT Chemistry and ANY other Science test or AP Statistics and ANY other Mathematics test, or SAT World History Subject Test and ANY other History/Social Studies test) WILL NOT be accepted. Please attach photocopies of the qualifying SAT Subject Test or AP scores and enter subjects and scores below. Subject Score Subject Score *If only one AP or SAT Subject Test score is available, you may substitute evidence of another academic achievement. Please list the achievement here and attach documentation of that achievement. Academic Achievement and Discipline Year Completed Submission: For confidentiality and security purposes, please: DO NOT SEND APPLICATIONS OR SUPPORTING DOCUMENTATION DIRECTLY TO ESE! Please submit this application to your high school s Koplik coordinator for review no later than May 1 st of your senior year. AP Exam and some SAT Subject Test scores arrive at your high school in the summer submit your application to your high school s Koplik coordinator for review no later than May 1 st of your senior year. Your guidance counselor will notify the Department of Elementary & Secondary Education when all of your scores and other documentation have been received and approved (indicated by the Koplik coordinator s signature below). Successful applicants will receive the Certificate of Mastery with Distinction from the Massachusetts Department of Elementary & Secondary Education. You may not make an initial application after you have graduated from high school. Verification: The Koplik Coordinator attests to the accuracy of the information provided in this application form by his/her printed name and signature below. Koplik Coordinator s name (printed) Signature/date Koplik Certificate of Mastery with Distinction Page 6 of 6