paper application - Community Leadership Center at Rutgers

Rutgers, The State University of New Jersey
501 Cooper Street
Camden, New Jersey 08102
clc.camden.rutgers.edu
856.225.6348
Fax: 856.225.6500
RUTGERS – CAMDEN AIM HIGH ACADEMY
The Rutgers-Camden Aim High Academy is an intensive three-week, residential summer program that seeks to
motivate and prepare rising 12th-grade students from South Jersey to enter and succeed in college. This program
will be held on the Rutgers-Camden Campus July 12, 2015 – July 31, 2015. Over the three-week period students
will participate in a unique college-exposure experience that includes:
• Rigorous, hands-on academic programming – with college-level course work in writing and
mathematics
• Seminars, led by university experts, focused on the college search, application, and financial aid
process
• SAT preparation classes, and the opportunity to take two practice SATs
• Technology integration: students will receive tablet computers (iPads) to integrate into their studies
and engage in a video design course. Upon successful completion of the Aim High program, students
will be permitted to keep the iPads
• Trips to colleges in the region and educational and cultural field trips to Philadelphia and
Washington, D.C.
• Workshops on study skills, test taking strategies, time management, financial literacy, and
components of college success
• Leadership development and team building
• Career exploration and workshops on career options
TO APPLY TO THE RUTGERS-CAMDEN AIM HIGH ACADEMY, A STUDENT MUST:
• Be a rising, 12th-grader (i.e., entering 12th grade in the 2015-16 school year)
• Attend high school in New Jersey
• Be highly recommended by teachers and school administration
• Have the full support and participation of parent(s) and/or guardian(s)
• Be in good academic standing based on course grades
• Agree to participate in all required Aim High courses and activities
• Complete this application, and submit a high-school transcript and letter of recommendation
• Meet one of the following eligibility criteria: 1) Be a first-generation college student (i.e., one or
both of applicant’s parents/guardians do not have a four-year degree from an American college or
university), OR 2) Meet financial-need criteria (i.e., a family income level that would qualify the
applicant for the national free/reduced-price school-lunch program), OR 3) Both of the above
APPLICATION PROCESS:
• SUBMIT A COMPLETED APPLICATION AND ALL REQUIRED MATERIALS BY May 1, 2015
• You may submit this application online (http://clc.camden.rutgers.edu/aimhigh.html) or via mail,
email, or fax
• See “HOW TO SUBMIT” section, on final page of this application
MORE QUESTIONS?
• Please direct questions to your high-school counselor, teachers, and/or principal
• You can also contact RU-Camden Aim High Program Coordinator, Matthew McCaffrey (phone: 856225-2922, email: [email protected])
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Rutgers, The State University of New Jersey
501 Cooper Street
Camden, New Jersey 08102
clc.camden.rutgers.edu
856.225.6348
Fax: 856.225.6500
Rutgers-Camden Aim High Academy – Paper Application
(ATTENTION: If possible, please complete this application online. Find online application at our website:
http://clc.camden.rutgers.edu/aimhigh.html, click on the “Program Application” page and follow instructions)
STUDENT BIOGRAPHCAL INFORMATION
(Print Clearly or Type)
Name: (Last) _______________________________ (First) ____________________________
Gender: _________________
Date of Birth: _____________
High School: _____________________________________________________________________________
Race/Ethnicity/National Origin: (optional, for reporting purposes only, choose all that apply)
 Latino/Hispanic
 Asian (East/South)
 African American/Black
 White/Caucasian
 African
 Native-American/Pacific Isl.
Other: ____________________________________________________
Mailing Address:
City:
State:
_______
Zip Code:
Home Phone: ___________________ Student Cell Phone (if available): __________________
Student E-mail Address: ___________________________
Language(s) spoken at home (Write all that apply):
____________________________________________________________________
How did you hear about this program? (Check all that apply)
 Family/Friend
 Community Organization
 School
 Rutgers Faculty/Staff
 Church/ Place of Worship
 Other:_________________
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STUDENT ACADEMIC INFORMATION
Please complete the following, using the most up-to-date information possible:
Cumulative GPA: _________
Math GPA: _________
English GPA: _______
Name of Guidance Counselor: ___________________________________________________________________
Guidance Counselor Email Address: ______________________________________________________________
Have you taken the SAT or ACT test?
Yes, SAT ___
Yes, ACT___
If yes, what are your scores?
SAT Scores, Critical Reading: _________
Yes, both ___
No, I have taken neither ___
Writing: ________
Mathematics: _________
ACT Scores, Composite Score: _________
English: ______
Mathematics: ______
Reading: _______
Science Reasoning: ___
Yes _________
No _________
At this time do you plan to attend college?
_
If so, what are you considering for your major? _____________________________________________________
What career(s) are you interested in pursuing? _____________________________________________________
Please list the Math courses you have taken and the grades received in each course:
Course Name:
Grade:
Course Name:
Grade:
_________________________________
_______________________________________
_________________________________
_______________________________________
Please list the English courses you have taken and the grades received in each course:
Course Name:
Grade:
Course Name:
Grade:
_________________________________
_______________________________________
_________________________________
_______________________________________
List activities and leadership experiences (school extracurricular activities, community service, church
engagement):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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COLLEGE PREPARATION AND PLANNING
After graduating high school, do you plan to attend college?
 Yes
 No
 Not sure
If you answered “yes” to the previous question:
o Are there any colleges, in particular, that you are interested in applying to? (It’s
completely fine if you are not sure. If this is the case, just write "not sure.")
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
o Are you considering any major(s), in particular? (It’s completely fine if you are not
sure. If this is the case, just write "not sure.")
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
o Beyond college, are you considering any career(s), in particular? (It’s completely fine
if you are not sure. If this is the case, just write "not sure.")
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
o
If you were to start college tomorrow, what do you think would be the three greatest
challenges you would face?
1.
_____________________________________________________________________
2.
_____________________________________________________________________
3. _____________________________________________________________________
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WRITTEN STATEMENT
(Please write a response of approximately 250 – 500 words for each essay)
Question #1: Please tell us about why you would like to attend college? What are your motivations? How do you
hope this program will help you succeed in future academic and professional pursuits?
Question #2: Please tell us about one challenge you have faced in your life. What happened? How did you
overcome this challenge? Did anyone help you? What did you learn from your experience?
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PARENT/GUARDIAN INFORMATION
1. First Parent/Guardian
Name: _____________________________________ Relationship to Student: __________
Mailing Address (if different than student):
City: ____________________
State: _________
Zip Code: _________
Home Phone: _________________ Cell Phone: ________________ E-mail Address: _______________________
2. Second Parent/Guardian (If applicant is primarily or regularly in contact with only one parent/guardian, then this
section may be left blank)
Name: ______________________________________Relationship to Student: _________
Mailing Address (if different than student):
City: ____________________
State: _________
Zip Code: _________
Home Phone: ___________________ Cell: _______________ E-mail Address: __________________________
Does the first-listed parent/guardian have a four-year college degree or an advanced degree from a United
States college or university?
 Yes
 No
If yes, which University? _________________________________________________________________
If no, what is the highest level of education completed? _______________________________________
Does the second-listed parent/guardian have a four-year college degree or an advanced degree from a United
States college or university? (If there is no second parent/guardian listed, leave question blank)
 Yes
 No
If yes, which University? ________________________________________________
____
If no, what is the highest level of education completed? _______________________________________
Does the first-listed parent/guardian have a four-year college degree or an advanced degree from a college or
university outside of the United States?
 Yes
 No
If yes, which University? _________________________________________ Country________________
Does the second-listed parent/guardian have a four-year college degree or an advanced degree from a college
or university outside of the United States? (If there is no second parent/guardian listed, leave question blank)
 Yes
 No
If yes, which University? _________________________________________ Country________________
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2014 FINANCIAL VERIFICATION INFORMATION
(To be completed by Parent or Guardian)
Family Information
How many people (including yourself) live in your household? _____
How many people in your household are claimed as dependents (Note: This should number should not include the head(s) of
the household) ? _____
Are school-age children in your household currently eligible to receive free or reduced-price school lunches
under the Federal Government’s National School Lunch Program?  Yes
 No  Not sure
Financial Information
What was your family's approximate gross income (pre-tax income) in 2014?
(Please use the following format: $000,000.00)
______________
_
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APPLICATION CERTICATION
Thank you for filling out an application to the Aim High Academy. Before submitting, please review the
information you have entered, as well as your essays. Ensure that what you have written is, to the best of your
knowledge, correct and accurate. Any information entered that is incorrect or inaccurate could jeopardize your
chances being accepted to the Rutgers-Camden Aim High Academy. After reviewing the application, and making
any necessary changes, please read the Certification Statement below, and sign if you agree.
Certification Statement:
To the best of my knowledge, I certify that the information I have entered into this application is correct and
accurate. Additionally, I understand that any information that is either incorrect or misleading -- entered either
by mistake, or otherwise -- could result in a disqualification of my application to the Rutgers-Camden Aim High
Academy.
Signed: _______________________________
Applicant Name (Print)
_____________________________ _
Applicant Signature
Date (mm/dd/yy)
Upon signing, your application is complete. Please follow the instructions for submitting both this application,
and the supplemental materials. Those instructions appear on the proceeding pages, and they can be found on
the “Program Application” page of our website: clc.camden.rutgers.edu/AIMApplication.html
Finally, thank you for taking the time to submit this application. Although completion and submission of this
application does not, by itself, signify acceptance into the Rutgers-Camden Aim High Academy, it is a big and
necessary step. It's also an accomplishment. We know it takes time, and effort. And, we appreciate it.
Please let me know if you have further questions or concerns. You can reach me via phone (856-225-2922) or via
email ([email protected]).
Good Luck!
Sincerely,
Mathew McCaffrey
Rutgers-Camden Aim High Academy Program Coordinator
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CHECKLIST OF FORMS:
***INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED***
This Application Checklist – Mark all that are completed:

Student Application: all sections are completed, application certification page signed

Both Written Statements: completed by the applicant
Supplemental Paperwork Checklist
•
Recommendation Letter and Recommendation Form: One letter of recommendation (from a
teacher, guidance counselor, mentor, supervisor, etc.) and one completed recommendation form
(recommendation form can be found on the next page of this document as well as on the “Program
Application” page of our website — http://clc.camden.rutgers.edu/AIMApplication.html).
•
Student Transcript: A copy of the applicant’s official high school transcript must accompany this
application, or it must be sent via email, fax, or mail prior to 5/1/15.
1. Please indicate how you intend to submit the Recommendation Form and Recommendation Letter:

Will be submitted with this current application

Will be submitted separately, no later than 5/1/15
2. Please indicate how you intend to submit the Recommendation Form and Recommendation Letter:

Will be submitted with this current application

Will be submitted separately, no later than 5/1/15
DISCLAIMER: Completion of this application does not signify acceptance into the Rutgers-Camden Aim High
Academy.
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RECOMMENDATION FORM
(To be completed by the person writing the applicant’s letter of recommendation)
All Rutgers-Camden Aim High Applicants are required to submit a letter of recommendation with their
application. As a reference to an applicant, we ask that you complete this form and write a letter
explaining why the applicant would be great for Aim High, and why Aim High would be great for the
applicant. To learn more about the Rutgers-Camden Aim High Academy, please visit our website
(http://clc.camden.rutgers.edu/aimhigh.html) and blog (http://aimhighacademy.tumblr.com/).
Please submit the letter no later than May 1, 2015. You may submit the letter of recommendation in
the following ways:
1. Via Fax. You may fax this document and the letter to 856-225-6500. Please direct the fax to
the attention of Matt McCaffrey.
2. Via Email. You may email this document and the letter to [email protected].
Please make sure to write “Letter of Recommendation” and the student’s name in the subject
line.
3. Via Postal Mail: You may mail the information to the following address:
Matt McCaffrey
Community Leadership Center at Rutgers-Camden,
501 Cooper Street, Floor 3
Camden, NJ 08102.
Student Applicant:
Your Name:
Title: __________________________________ Daytime Phone #:
School/Organization:
Relationship to applicant: ___________________ _ How long have you known the applicant? _______________
Please attach a personal statement regarding the applicant. Feel free to describe an experience you have had
with the applicant so we can better understand their personality and ambition.
____________________________________
Signature/ Date
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Rutgers, The State University of New Jersey
501 Cooper Street
Camden, New Jersey 08102
clc.camden.rutgers.edu
856.225.6348
Fax: 856.225.6500
HOW TO SUBMIT
APPLICATIONS DUE May 1, 2015
Please submit a COMPLETED application, to your school’s Principal or Guidance Counselor, OR send
application directly. All applications are due May 1, 2015.
Applications may be completed online or sent via mail, email, or fax. Submission instructions below:
1. Online Submission: Submitting application online is strongly encouraged. Find online application
at: http://clc.camden.rutgers.edu/aimhigh.html. Click on the “Program Application Page” and
follow instructions to the online application.
Note: Submit supplemental paperwork (letter of recommendation, transcripts, essays, etc.) via
mail, email, or fax (see instructions above, for these modes of delivery).
2. Paper Submission: Alternative to online applications, paper applications may be downloaded from
our website (http://clc.camden.rutgers.edu/aimhigh.html) and submitted via the following:
a. Mailing – Please send application to:
Matthew McCaffrey
Community Leadership Center at Rutgers-Camden
501 Cooper Street, Fl. 3
Camden, NJ 08102
b. Scanning/Emailing Instructions – Please send application to the following address:
Matthew McCaffrey: [email protected]
c. Faxing Instructions – Please fax application to the following number, to the attention of
Matthew McCaffrey: (856) 225-6500
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SUBMITTING SUPPLEMENTAL DOCUMENTS
Although the supplemental information does not need to be sent at the exact same time as your
Rutgers-Camden Aim High Application, supplemental paperwork must be received by the RutgersCamden Aim High Academy no later than May 1, 2015.
All supplemental paperwork should be sent by mail, email, or fax. Addresses/fax number are as
follows:
• Mailing Address
Matthew McCaffrey
Community Leadership Center at Rutgers-Camden
501 Cooper Street, Fl. 3
Camden, NJ 08102
• Email Address – Matthew McCaffrey: [email protected]
• Faxing Instructions – Please fax supplemental paperwork to the following number, to
the attention of Matthew McCaffrey: (856) 225-6500.
Advice on submitting supplemental paperwork:
Transcripts: Your high school already has procedures in place for sending student
transcripts. You should discuss this with your counselor to ensure the transcripts will be
sent.
• Letter of Recommendation: Please ask one teacher, guidance counselor, mentor,
supervisor, etc. to write a letter recommending you to the Rutgers-Camden Aim High
Academy. Please make sure that person also completes the Rutgers-Camden Aim High
Recommendation Form. Provide the person writing your recommendation with
information on how to submit.
o Recommendation Form: Please give the Recommendation Form to the person
writing your letter of recommendation, and advise that person to send it
together with your recommendation letter.
***NOTE: Applications missing supplemental paperwork will not be considered for the program***
Notification: Students will be notified regarding their acceptance status in mid-May, 2015. Those
who are accepted will receive be notified via email, and subsequently receive an official acceptance
packet from the Rutgers–Camden Aim High Academy.
•
***INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED***
Notification:
Students will be notified regarding their acceptance status in mid-May. Those who are accepted will receive an
official email and will be mailed an acceptance package from the Rutgers –Camden Aim High Academy.
FURTHER QUESTIONS/ GENERAL INQUIRIES:
Please contact Aim High Program Coordinator
Matthew McCaffrey – 856-225-2922 or [email protected]
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