PSEO at YEAH Application Form

Transcription

PSEO at YEAH
One Application
Application Checklist
Check off items included to ensure your application is complete
PSEO at YEAH Application form
Character Reference form
High School Transcript
College Entrance Exam score
NSR Form can be found here: http://yeahacademy.net/2014%20NSR%20form.pdf
NSR form for North Central University, Minneapolis
NSR form for Concordia, St Paul
NSR form for University of Northwestern, St Paul
Proctored Writing Sample
FERPA form
Mail in a manila envelope to:
PSEO at YEAH Admissions
c/o Linda Lopez
5841 Lametti Lane,
Shoreview, MN 55126
If completed during the YEAH Academy session, the application may be turned in
Mon-Wed 8am-4pm at The Academy Office
Dates to Know:


November 1st: deadline to submit application for spring semester classes
January 12: Student Success Workshop for students new to PSEO
[PSEO at YEAH]
All students interested in participating in PSEO at YEAH must complete this Application and include
all required documentation to be considered for enrollment.
Dear PSEO Applicant,
We are pleased to offer you an opportunity to participate in our PSEO program through North Central University,
Minneapolis; Concordia University, St Paul and University of Northwestern, St Paul. Our program is designed to help
you develop in your academics and also who you are as a person. We are committed to equipping you for future
success, and because of that we will truly focus on you and your goals. Please be assured that throughout your
application process, we are here to serve you. If you have any questions, please email ouryeahservices@gmail.com.
Linda López
Cher Baumhoefner
Dr. Skip Baumhoefner
PSEO at YEAH Council & Coordinators
Application Modified from NCU’s PSEO Application
Steps in Applying to PSEO at YEAH’s Program
YEAH offers the PSEO program through three universities: North Central University (NCU), Concordia University, St
Paul (CSP) and University of Northwestern, St Paul (UNWSP). For ease of application this form is a joint application
which permits you to apply to all three Universities at the same time. This will allow you to take advantage of all the
PSEO at YEAH courses without needing to complete duplicate information for each Partner University.
Eligibility
High school juniors and seniors who meet the following Admissions requirements may apply and be admitted to the
PSEO at YEAH program:
 Minnesota Resident: Only Minnesota residents are eligible for the PSEO program
 Be registered as a high school Junior and Senior
 Must be a home educated student.
 High school GPA of 3.5
 ACT score of 18, SAT score of 850 (optional writing portion not included), PLAN or PSAT score of 50% or
higher. For the PLAN or PSAT please photocopy the score results
 For the ACT you will need: NCU School code: 002369; UNWSP school code: 2138
 For the SAT you will need: NCU school code: 0051; UNWSP school code: 6489
 Ability to succeed at the academic rigor of college
Application Procedures
The follow documentation is required in order for a student’s application to be reviewed for admissions into the PSEO
at YEAH program:
1. PSEO Common Application form
 This form is used to apply for all programs associated with PSEO at YEAH, including NCU, CSP and
UNWSP
2. Character Recommendation form
 This form should be completed by a teacher other than the parent, guidance counselor or school
administrator who knows the student. Recommendation forms completed by relatives will not be
accepted
3. High School Transcript
 This must be an official transcript from a high school/homeschool through at least the middle of
sophomore year for junior applicants and through the middle of the junior year for senior applicants.
4. College Entrance Exam
 ACT score of 18 (optional writing portion scores not included)
 SAT score of 850 (optional writing portion scores not included)
 PLAN or PSAT Standardized Tests – Must score at 50% or higher
5. NSR (Notice of Student Registration) form
 This form must be completed every semester for each university at which the student is planning to
attend
6. Proctored Writing Sample
 We are looking for college level writing including focused content, organization, word usage and
general quality of writing
7. FERPA form
 Must be completed and turned in
© PSEO at YEAH 2014
page 1
last update: 9.24.2014
PSEO at YEAH Application
Personal Information
Full Name:
Last
First
Telephone:(
)
Middle
Email:
Present Address:
Street Address
Apartment/Unit #
City
State
Check one:
Male
Female
Citizenship:
U. S. Citizen
Ethnicity:
Hispanic/Latino
Date of Birth:
/
ZIP Code
/
Resident Alien Resident Alien #: _____________________________
Select one or more races:
Refugee
Other
Non-Hispanic
Native Hawaiian or
Pacific Islander
American Indian or Alaskan Native
Asian
Black or African American
White/Caucasian
Prefer Not to Answer
Church
City/State
Pastor
Prefer Not to Answer
Denomination
Parent/Legal Guardian Information
Mother
Father
Guardian
Mother
Name:
Name:
Address:
Address:
City/State/Zip:
City/State/Zip:
Telephone: (
)
Telephone:
Father
(
Guardian
)
Enrollment Information
PSEO Program Type- Select all college(s) applying to this year:
Already accepted this year or last year at:
Partner Program: YEAH & North Central University, Mpls.
YEAH and NCU
Other
Partner Program: YEAH & Concordia University, St Paul
YEAH and CSP
Specify:
Partner Program: YEAH & University of Northwestern, St Paul
YEAH and UNWSP
Desired Enrollment Date
Desired Status
Fall, 20 ____
Full-time PSEO
Spring, 20____
Part-time
(Both PSEO & non-PSEO classes)
Are you interested in any of YEAH’s Partner Universities after High School?
Intended College Major:
Major Undecided
North Central
Northwestern
Concordia
Education
City:
Name of High School:
High School Graduation Year:
page 2
Unknown
None
Finances
Students participating in PSEO at YEAH are released from most fees, including an application fee, tuition,
technology fee, fees for eligible courses, student I.D. cards (if available), and the cost of all required textbooks.
Students are responsible for incidental school supplies (paper, pens, athletic equipment, etc). PSEO students are not
eligible for any additional financial aid.
PSEO at YEAH does require YEAH Academy Family Membership ($45.00 per academic year), a $20.00
administration fee per semester, and a $5.00 per credit processing fee, payable at time of registration. Lab fees (for
art and science courses) are also additional and vary depending on the course.
If a PSEO student chooses to take a class on NCU’s Downtown Campus, CSP campus or UNWSP campus
which is not approved under state guidelines for PSEO the student would be responsible for all tuition, fees, and
textbooks associated with that class.
Textbook Agreement
I agree to return all textbooks and class resources to their appropriate location at the end of each semester:
North Central University, Minneapolis
Yes – I will return textbooks and class resources to the NCU Downtown campus upon completion of
course(s) in a timely manner
No – I understand that I will be responsible for the cost of any non-returned textbooks or resources
Concordia University, St Paul & University of Northwestern, St Paul
Yes – I will return textbooks and class resources to the YEAH Academy campus upon completion of the
course(s) in a timely manner
No – I understand that I will be responsible for the cost of any non-returned textbooks or resources
Permissions & Code of Conduct, Appearance, and Behavior
YEAH and each Partner University of PSEO at YEAH has a Code of Conduct which they require students to read and
sign. Students must read each and reply as is appropriate.
The YEAH Academy
I have read and understand The YEAH Academy’s Code of Conduct as outlined at
www.YEAHAcademy.net/behavior.htm and agree to follow its guidelines with the understanding that any breech will
result in disciplinary action, up to or including expulsion from the PSEO at YEAH program.
________________________________________________________________ ______________________________
Student Signature
Date
University of Northwestern, St Paul
I understand that Northwestern is a distinctively Christian university that carries out its mission within the framework
of the Christian worldview. I affirm with my signature that I have read the Declaration of Christian Community (see
UNWSP.edu for specifics). If I am accepted and subsequently enroll as a PSEO student at UNWSP, I will gladly adhere
to its spirit and standards and will seek to be a positive, active member of the UNWSP community.
I also affirm that all information contained in this application is accurate, complete, and honestly presented.
________________________________________ ________________________________________ __________________
Student Signature
Printed Name
page 3
Date
Concordia University, St Paul
I hereby give Concordia University, St Paul permission to use my likeness in any promotional or news release
generated by the university or any agent appointed by the university. This information may contain photos,
quotations or statistical information about myself. I also give Concordia University permission to print my name in
regard to any honor I receive from the university.
North Central University, Minneapolis
The faculty, staff, and students of North Central University are committed to the person of Jesus Christ and to the
concept that the principles and practices set forth in the Bible will enhance and be evident in the life of every student
enrolled at the University; therefore, North Central maintains high Christian standards. North Central reserves the
right to dismiss a student who, in its judgment, does not abide by the stated policies governing students. Students are
expected to refrain from behavior which includes the following: possession and use of non-medical drugs, tobacco,
and alcoholic beverages; sexual immorality (including promiscuity and homosexuality) and pornography; gambling,
theft, and entertainment that is against North Centrals University community life standards.
Have you participated in any of the above mentioned behaviors in the past year?
Yes
No
If yes, please list date of discontinuance and reason why: _________________________________________________
Have you ever been placed under court probation or sentenced for any reason?
Yes
No
If yes, please explain the circumstances: _______________________________________________________________
I certify that all information in this application is complete and accurate. I understand that acceptance to North
Central University is subject to verification of final records form all institutions I have attended. If accepted, I agree
to observe all policies and standards of the University on and off campus.
I agree to live by the expectations in the North Central University community?
Yes
No
If no, please explain: ________________________________________________________________________________
________________________________________________________________ ______________________________
Student Signature
Date
Academic Dishonesty & Plagiarism Policy
The YEAH Academy Policy Statement on Cheating and Plagiarism
Background: In the age of technology, it has become increasingly easy to use tools to research information for
schoolwork. In fact, it is quite simple to buy ready-made essays and research papers. It is effortless for students to
cut and paste information from an internet site onto a word processor and attempt to pass that work off as their own.
When students use technology to illegally and unethically download music, movies and games, it is not much of a leap
to “download” ideas, formats, phrases, sentences and whole papers. Through ignorance or laziness, students often
copy so many words/ideas/information from a resource that it becomes merely a strong of other people’s work. In is
unfortunate that policies regarding cheating have to be outlined.
Four of the Ten Commandments can be used as an ethical basis of correct behavior when it comes to turning in
homework and writing papers:
1. Thou shall not covet (another person’s ideas or works)
2. Thou shall not steal (another person’s ideas or works)
3. Thou shall not bear false witness (by presenting someone else’s work as your own)
4. Honor thy mother and father (They pay for your classes. Honor their investment in you by doing your best)
page 4
Cheating and Plagiarism includes, but is not limited to:
 Buying, borrowing or using another person’s work as your own, even with their permission
 Copying off another person’s homework, quiz or test
 Having another person (including your parents, siblings or friends) do your work for you
 Using one paper for more than one class (in or outside of The Academy), without the express permission of
both tutors/instructors/professors
 Copying or paraphrasing another person’s facts, information, statistics, words, format, research, photos,
music, ideas, graphics, etc. without telling the reader where you got your information by using proper citation
 Cutting and pasting information into your paper without using quotations and proper citations
 Giving incorrect information about where information originated
If a student is found to have cheated or plagiarized, the professor needs to bring it to the attention of the student and
the parent. Depending on the extent of the cheating, they may be asked to meet with The Academy Administrator or
The Academy Board.
It is the intention of The Academy professors to help students understand the severity of cheating and plagiarism in a
firm, but compassionate manner. Possible consequences include:
 Having to redo the homework or paper
 Receiving a failing grade on the homework or paper
 A failing grade in the course
If the offense is repeated or a student refuses to comply, further disciplinary action may be taken including expulsion
from the class and/or PSEO at YEAH itself.
Student Statement of Understanding
By signing below, I hereby declare that I understand The Academy’s Academic Honesty & Plagiarism
Policy and agree to comply with it. I also understand that failing to comply will result in disciplinary
action as outlined above.
_______________________________________________________________________ ____________________________
Student Signature
Date
Applicant’s Confirmation of Authentication
I affirm with my signature that all information contained in this application, including any attached documentation, is
accurate, complete, and honestly presented.
Student Signature
Print Name
Date
Mail Application in a manila envelope to:
PSEO at YEAH Admissions
c/o Linda Lopez
5841 Lametti Lane,
Shoreview, MN 55126
page 5
YEAH FERPA Waiver Form
The Family Educational Rights and Privacy Act (FERPA) of 1974, is a federal law that establishes the
rights of students with regard to education records, and ensures students of the right to privacy and
confidentiality with respect to those records. This form is provided as a means for students to give
the faculty of PSEO at YEAH permission to discuss and/or disclose their academic records with
someone other than themselves (i.e., with a parent, guardian, etc.).
STUDENT’S AUTHORIZATION TO RELEASE INFORMATION
In signing this wavier, I, ____________________________________________(print name), give access to all
my academic records at PSEO at YEAH and their Partner Universities (North Central University,
Concordia University, St Paul and University of Northwestern, St Paul) to the individual(s) listed
below. I also give permission to my university professors to discuss my classroom work with those
listed below.
_______________________________________________________________
Name
_____________________________
Relationship to student
_______________________________________________________________
Name
_____________________________
Relationship to student
I understand this authorization remains in effect as long as I am a student at YEAH or their Partner
Universities or until I revoke this authorization in writing.
I have carefully read the forgoing authorization and fully understand the meaning of this wavier form.
I affirm that I have signed this authorization voluntarily.
_______________________________________________________________
Student’s Full Name (please print)
_____________________________
Date of Birth
_______________________________________________________________
Student’s Signature
_____________________________
Today’s Date
ACKNOWLEDGEMENT of DROP CONSEQUENCES
I understand that if I decide to drop any of my registered classes, I (not my parents) need to contact the registrar for
YEAH (Skip Baumhoefner: skipb@mtn.org). He will advise me of the correct procedure for the appropriate college. In
general, I have two weeks after the start date of the course to drop a course with no transcript notation. After the
drop deadline, I understand that I will receive “W” on my transcript. I understand that dropping a course can affect
future financial aid awards. I also understand that after the drop date, I will receive my earned grade. As with all
grades, a failed class will be noted on the transcript and this transcript will follow me throughout my educational
career.
_______________________________________________________________
Student’s Signature
page 6
_____________________________
Today’s Date
PSEO 30-MINUTE PROCTORED WRITING SAMPLE
Student Information (please print)
Full Name:
Last
First
M.I.
Address:
Street
City
State
Zip
Student Signature
Date
Proctor Information (please print)
Full Name:
Last
First
Position:
Signature:
Writing Sample Instructions







The writing sample must be handwritten in blue or black ink
The student may not use any writing aid – including a dictionary, thesaurus, computer, etc
The proctor cannot be a family member
The student should take no more than 30-minutes to complete their writing sample, but does
not need to write for the entire 30-minutes
Essay must include an introduction, multi-paragraph body, and conclusion; approximately 500
words minimum.
Writing sample must be completed before application will be considered
Write your essay on the lined paper provided. You do not have to use all three sheets!
Please write on the following topic:
How will PSEO at YEAH help me achieve my future goals?
page 7
Name
Date
page 8
page 1
Name
Date
page 9
page 2
PSEO AT YEAH
CHARACTER RECOMMENDATION
①
To the Applicant:
This recommendation form should be completed by a non-parent teacher, professor, guidance
counselor, employer, or school administrator. References from family members are not accepted. Please
complete the following information and forward this form to your reference for completion.
Full Name of Applicant (Please Print)
Address of Applicant
City
State
Zip
Phone number
Email of Applicant
Applicant’s wavier of right of Access to Confidential Statement: I willingly waive my right of access to see this
confidential reference understanding that signing this waiver is not required as a condition for admission.
Applicant Signature
Date
② To the Teacher/Guidance Counselor/Employer:
The student named above is required to submit this form before admission to North Central University,
Minneapolis, Concordia University, St Paul, and/or University of Northwestern, St Paul through a
partnership with PSEO at YEAH can be considered. We value your comments and request that you give
a full and candid report so that fair consideration may be given to the applicant. Your prompt attention is
appreciated. If this form is not adequate for your remarks, please attach additional information. If you
feel that you do not know the student well enough to give a complete reference, please refer the student
to another person.
Confidentiality: Federal law gives students to option of waiving their right to see specific letters of
recommendation. If the application has not signed the waiver statement above, we will assume that you
are submitting information with full knowledge that it may be seen by the applicant if he or she is
accepted at any partner university of PSEO at YEAH. If above waiver is signed, your recommendation
will remain confidential.
1. How long have you known the applicant?
2. How well do you know the applicant?
3. Please list the student’s involvement in activities at your institution or place of employment:
page 10
4. Please comment on any positive or negative characteristics you have observed in the life of the
applicant (personal, social, academic, etc.):
5. Has the applicant ever been dismissed or suspended?
No
Yes
If yes, please explain:
6. How do you rate this person in the following areas? (Please mark an X along the line.)
Excellent
Above Average
Average
Below Average
Academic Ability
Anticipated Achievement in College
Communication Skills
Cooperativeness
Emotional Stability
Initiative/Motivation
Integrity & Honesty
Leadership
Responsibility
Social Adaptability
page 11
No chance to
observe
7. What specific encouragement, guidance or supervision would you suggest?
8. What additional information can you provide about this applicant that may help us in making our
decision?
9. To your knowledge has the applicant used the following in the past year:
Alcoholic Beverages:
Yes
10. Recommendation:
No
Tobacco:
I recommend
Yes
No
Non-Medical drugs:
I recommend with reservation
Name (Please Print)
Name of School/Organization
Telephone
Address
City
Character Recommendation Signature
State
Date
Please return to:
PSEO at YEAH Recommendation
5841 Lametti Lane,
Shoreview, MN 55126
page 12
No
I do not recommend
Please print the information below
Position
Yes
Zip

PSEO at YEAH Application Form

Transcription

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