1. education
2. graduate school
3. college

American Indian Summer Bridge Program South Mountain Community College Summer Form June 01, 2015 – June 25, 2015 Program Information The American Indian Summer Bridge Program is grant­funded by the Salt River Pima Maricopa Indian Community. Implemented with the coordinated efforts of the Maricopa Community Colleges Office of American Indian Outreach, this summer bridge program focuses on recruiting American Indian males in 8th grade. This summer program is a great scholarship opportunity to expose American Indian males currently in 8th grade to a college environment and offer them a college experience in an effort to spark and/or support their educational goals of earning college credit. Summer Program benefits are: ●
●
●
●
●
●
Tuition and fees paid Earn college credit Lunch provided Visit a higher educational institution Opportunity to hear about community colleges Introduce other bridge programs such as Hoop of Learning This program is supported by the Maricopa Community Colleges District Office – Division of Academic and Student Affairs and South Mountain Community College’s Student Affairs Department along with the South Mountain Community College Office of Early Outreach. APPLICATION DEADLINE: Friday, April 24th, 2015 1
American Indian Summer Bridge Program South Mountain Community College Summer Form June 01, 2015 – June 25, 2015 Student First and Last Name: Date of Birth: School Name Grade: Gender: Social Security Number: Guardian/Father’s Name: Guardian/Mother’s Name: Street Address: City, State, Zip Code: Parent/Guardian Email Address: Guardian/Father’s Phone Number: Guardian/Mother’s Phone Number: Please circle one: 8 th Grade Male I live with my: Mother Father Both Parents Guardian Other I am a U.S. Citizen: Yes No I am enrolled in a Federally Recognized Tribe: Yes No Please indicate Tribe: I am a first generation college student: Yes No 2
(You are a first generation student if both parents or guardians did not complete a bachelor’s degree) What High School will you be attending after Junior High? Do you have a computer and internet access at home? What is your G.P.A.? How did you hear about the American Indian Summer Bridge Program? Have you ever participated in a summer program or camp? Have you ever visited or toured a College or University campus? Do you want to go to college after High School? What do you want to be when you grow up? Do you have any food allergies the program needs to be aware of? Are there any physical limitations the program needs to be aware of? Emergency Contact Information Name ___________________________________________ Phone _____________________________ Relationship to student ____________________________________________ 3
************** STUDENT COMMITMENT/ACCEPTANCE OF GUIDELINES As a participant in the American Indian Summer Bridge Program, I agree to the commitment/acceptance of the following: ●
●
●
●
●
●
●
Mandatory attendance of the orientation/registration with my parent/guardian Participation in all events/activities related to the program Consent for the release of my academic information, as necessary for program use Compliance with all district and college policies and procedures Consistent class attendance in all enrolled courses Consent to participate in surveys and studies for continued program involvement Consent to the release and use of photographs, video, filming, and recordings for the use in program, college, and district publications and development of promotional and/or marketing materials. As a selected participant of the American Indian Summer Bridge Program, I commit to the goals of the program and will fully participate in all aspects of the program. I am open to learning, growing, and contributing to my academic and personal growth. Student Signature __________________________________________ Date __________________________ ************* PARENT/GUARDIAN INFORMATION AND COMMITMENT CLAUSE I give my permission for my child to participate in the American Indian Summer Bridge Program. I understand that my child will be required to participate in program activities, events, and the college course. I understand that I must agree to attend the Parent/Guardian Orientation on May 20, 2015. I have reviewed and agree to assist my child in following the student commitment/acceptance guidelines of the American Indian Summer Bridge Program. As the parent/guardian, I commit to providing the needed support to ensure success. Parent/Guardian Signature _________________________________Date _____________________________ For more information on this program, please contact: Gerard Begay at (480) 731­8277 / [email protected] Or Wilbert Begay at (480) 731­8018 / [email protected] 4
APPLICATION DEADLINE: Friday, April 24th, 2015 Recommendation Form Student: Last Name_______________________________________ First Name_______________________________________ Middle Name_____________________________________ School Name_________________________________ Candidate Instructions: This form is to be completed by an adult not related to the American Indian Summer Bridge Program candidate such as a school counselor, teacher, coach, or pastor. • Allow your recommender at least one week to complete the form. • Ask your recommender to place the form in a sealed envelope. • Submit the sealed recommendation envelope with all other application documents by your specified deadline. Recommender: The student listed above is in the process of applying to American Indian Summer Bridge Program. The student’s present grades may not reflect his or her potential. Your feedback will help us determine whether this candidate has the potential to benefit from our program. Recommender Name:________________________________________________________________ Professional Title:_________________________________________________________________ School/Community Organization:___________________________________________________________ E­mail:________________________________________________________________ Contact Number:_______________________________________________________________ How long have you known the candidate? ______Months ______Year(s) Please rate the student on the following factors, from 1 (low) to 5 (high). Character and Personality
Low
1. Shows respect towards adults
1 2
3 4
5 2. Respects other students
1 2
3
4 5 3. Respected by others 1 2 3 4 5 5
High 4. Politeness and manners 1 2 3 4 5 5. Leadership traits 1 2 3 4 5 6. Personal Initiative 1 2 3
4 5 7. Organization 1 2 3
4 5 8. Accepts constructive criticism 1 2 3 4 5 9. Positive attitude 1 2 3 4 5 10. Accountability 1 2 3 4 5 11. Dependability 1 2 3 4 5 Academics Low High 1. Motivation to learn 1 2 3 4 5 2. Self­discipline in the classroom 1 2 3 4 5 3. Completes assignments on time 1 2 3
4 5 4. Neatness of assignments
1 2 3 4 5 5. Punctuality 1 2 3 4 5 6. Overall attendance 1 2 3 4 5 1. Please comment on the student’s potential and personal characteristics. ____________________________________________________________________________________ __________________________________________________________________________________________
______________________________________________________________________________ 2. What else should the selection committee take into consideration when assessing this candidate’s application packet (strengths, challenges, extracurricular activities that may impact quality of work)? __________________________________________________________________________________________
__________________________________________________________________________________________
________________________________________________________________________ Recommendation: Do you recommend this student for enrollment in our American Indian Summer Bridge program­ Circle one below. Yes
Some Concerns
Please provide a brief comment below if Some Concerns or No is circled. 6
No __________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________ Recommender Signature________________________________________Date_______________________ Thank You. Your response is greatly appreciated. Please place the recommendation form in an envelope, seal, sign across the seal, and return to the student with completed recommendation form. 7