PSEO at YEAH Application Form
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 [email protected]. 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: © PSEO at YEAH 2014 page 2 last update: 9.24.2014 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 © PSEO at YEAH 2014 page 3 Date last update: 9.24.2014 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) © PSEO at YEAH 2014 page 4 last update: 9.24.2014 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 © PSEO at YEAH 2014 page 5 last update: 9.24.2014 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: [email protected]). 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 © PSEO at YEAH 2014 page 6 _____________________________ Today’s Date last update: 9.24.2014 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? © PSEO at YEAH 2014 page 7 last update: 9.24.2014 Name Date © PSEO at YEAH 2014 page 8 page 1 last update: 9.24.2014 Name Date © PSEO at YEAH 2014 page 9 page 2 last update: 9.24.2014 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: © PSEO at YEAH 2014 page 10 last update: 9.24.2014 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 © PSEO at YEAH 2014 page 11 last update: 9.24.2014 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 © PSEO at YEAH 2014 page 12 No I do not recommend Please print the information below Position Yes last update: 9.24.2014 Zip
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