Jefferson County International Baccalaureate School
Middle Grades Application
Applicant: Last _______________________ First ________________________ Middle ___________
Address: _____________________________________________________________________________
City: _____________________________________________ State: _______ Zip Code: ____________
Home phone number: ___________________________
Parent Cell: __________________________
Parent/Guardian (primary contact regarding Application): ____________________________________
Best time to reach this person: ______________ Alt. phone number: __________________________
Parent email: ______________________________
Birth date: ______________________ (mm/dd/year) Gender (circle):
Ethnicity (circle): African-American/Black
Asian
Male
Native American
Female
Other
White
(For Statistical Purposes Only)
Assigned Middle School: _________________________________________
Do you have prior experience with an International Baccalaureate Program? If so, please explain:
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Extracurricular Activities and/or Volunteering Activities:
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Applying for:
6th grade _______
7th grade _______
8th grade ________ (check appropriate line).
I understand the following regarding attendance at the Jefferson County International Baccalaureate School:
• Jefferson County only provides transportation to students living in a Jefferson County School Board zoned area. I am aware that if I am
not in these zoned areas that I am responsible for transporting my own student to and from school if accepted into the program.
• I am also aware that if I reside outside the Jefferson County School Board zone area, tuition and a release from my school board will be
required by August 1st to the Department of Student Services at the Jefferson County Board of Education.
• JCIB students are required to maintain a minimum academic grade point average of 2.5 and maintain exemplary behavior. If a student
does not meet either of these requirements, they may be dismissed from the program.
• The IB Diploma is an alternative pathway to graduation. A student who completes the all requirements for an IB Diploma will earn an
Alabama High School Diploma with an Academic Endorsement and may possibly earn an International Baccalaureate Diploma which
would be awarded during the summer of their graduating year.
•
I understand that JCIB is in the process of applying as a candidate school for the Middle Years Programme. Once accepted as a
candidate school, JCIB will pursue authorization as an MYP IB World School. Candidate status gives no guarantee that
authorization will be granted. JCIB has been authorized in the Diploma Programme since 1991.
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_________________________________
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Print Student’s Name
Parent/Guardian Signature
Date
All parts of the application are due to Jefferson County Schools MYP Programme, 2100 18th Street South, Birmingham, AL 35209, by March 26, 2015.
International Baccalaureate Program Application for Middle Grades
Jefferson County International Baccalaureate School Middle Years Programme
Birmingham, Alabama
Test scores and current school recommendation
TO THE SCHOOL COUNSELOR OR ADMINISTRATOR: The student named in this Application has applied for
entrance into Jefferson County International Baccalaureate School. Please complete the items below and distribute the
attached recommendation forms to the student’s current teachers. In addition, we require a copy of students current
grades including if applicable (5th grade through first semester 7th grades) and a copy of the most recent standardized
test scores (EXPLORE, ASPIRE, Global Scholar PS, etc. ). Please return all portions of this application in one
envelope to Jefferson County Schools, Attention: MYP Programme, 2100 18th Street South, Birmingham, AL
35209, by March 26, 2015.
Student Name ______________________________________________
Please check all that apply, and include copies of all documents:
_____ 504 (Accommodation Plan) ______ GEP (Gifted Education Plan) ______ IEP (Individual Ed. Plan)
Has this student received a major disciplinary infraction, including any Class III infractions? _________
Please check the box that best fits the student’s achievement in the area indicated.
Below Average
Barely Average
Average
Above Average
Stellar
Attendance
Work Ethic
Maturity to
handle difficult
tasks
Peer interaction
If you would like to add any further comments about the student, please do so in the space provided below. You may
want to comment briefly on the suitability of the student’s participation in advanced studies. We would appreciate your
honesty in expressing any reservations you may have, and in helping put test scores and/or the student’s academic record
in context. ALL RECOMMENDATIONS ARE CONFIDENTIAL.
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______________________________________ _______________________________________
Print Name/Title
Signature
_______________
Date
Thank you for your time and attention to this application. Please remember a transcript and two recommendations are
required in order for this Application to be complete.
All parts of the application are due to Jefferson County Schools MYP Programme, 2100 18th Street South, Birmingham, AL 35209, by March 26, 2015.
Writing Prompt —-To be completed in your best handwriting, and on this page—In the space below and in your own
handwriting, complete only one of the following:
1) Mt. Rushmore has the faces of four famous presidents carved in it. If you were going to select four new people to place on
Mt. Rushmore, who would they be and why did you choose them.
2) Suppose you had the opportunity to travel anywhere you wanted. Write to explain where you would go and why you chose
your location.
3) Select one of your earlier years in school (Kindergarten, 1st grade, 2nd grade, 3rd grade, 4th grade, or 5th grade). Describe that
year and why you selected to write about it.
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All parts of the application are due to Jefferson County Schools MYP Programme, 2100 18th Street South, Birmingham, AL 35209, by March 26, 2015.
Jefferson County Schools MYP Programme
2100 18th Street South, Birmingham, AL 35209
205 379-2000
CLASSROOM TEACHER’S RECOMMENDATION FORM
Student: _________________________________ Elementary/Middle School: _________________________________
Teacher: _________________________________ Course taught: _______________________________________________
TO THE TEACHER: The above student is applying to JCIB. This rigorous academic curriculum challenges students to learn how to learn, analyze,
and reach considered conclusions about people, language and literature, and the scientific forces of the environment. Students must have established
strong scholastic backgrounds across all core subject areas. The successful student possesses a high degree of motivation, self-discipline, and a genuine
love of learning. Please return this form to the student’s counselor or to the address above by March 26, 2015.
Overall Recommendation:
_____ Highly Recommend _____ Recommend _____ Recommend with reservations ____ Cannot recommend
_____________________________________________________
Teacher Signature
________________________
Date
Check the column which best describes the student.
Academic Abilities
Never
Seldom
Sometimes
Usually
Always
1. Does the student demonstrate excellence on class assignments and
projects?
2. Does the student complete homework and outside-of-class work in a
timely and thorough manner?
3. Does the student grasp new or different concepts readily?
4. Does the student challenge, speculate, make unusual associations, or
draw unique conclusions?
5. Does the student take the initiative for his/her own learning?
6. Is the student’s oral and written communication clear, mature, and
correct?
7. Does this student demonstrate quick recall and mastery of factual
information?
Motivational Characteristics
Never
Seldom
Sometimes
Usually
Always
1. Does the student show genuine excitement and enthusiasm for learning?
2. Is the student able to be self-critical and self-correcting?
3. Does the student handle outside responsibilities as well as school
demands?
4. Is the student intellectually playful, curious, and imaginative?
5. Is the student self-confident and emotionally secure?
Comments: ___________________________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
THIS RECOMMENDATION IS CONFIDENTIAL
All parts of the application are due to Jefferson County Schools MYP Programme, 2100 18th Street South, Birmingham, AL 35209, by March 26, 2015.
Jefferson County Schools MYP Programme
2100 18th Street South, Birmingham, AL 35209
205 379-2000
ELECTIVE TEACHER’S RECOMMENDATION FORM
Student: ___________________________________ Elementary/Middle School: ____________________________________
Teacher: ___________________________________Course taught: _______________________________________________
TO THE TEACHER: The above student is applying to the JCIB. This rigorous academic curriculum challenges students to learn how to
learn, analyze, and reach considered conclusions about people, language and literature, and the scientific forces of the environment.
Students must have established strong scholastic backgrounds across all core subject areas. The successful student possesses a high degree
of motivation, self-discipline, and a genuine love of learning. Please return this form to the student’s counselor or to the address above by
March 26, 2015.
Overall Recommendation:
_____ Highly Recommend _____ Recommend _____ Recommend with reservations ____ Cannot recommend
_____________________________________________________
Teacher Signature
________________________
Date
Check the column which best describes the student.
Academic Abilities
Never
Seldom
Sometimes
Usually
Always
1. Does the student demonstrate excellence on class assignments and
projects?
2. Does the student complete homework and outside-of-class work in a
timely and thorough manner?
3. Does the student grasp new or different concepts readily?
4. Does the student challenge, speculate, make unusual associations, or
draw unique conclusions?
5. Does the student take the initiative for his/her own learning?
6. Is the student’s oral and written communication clear, mature, and
correct?
7. Does this student demonstrate quick recall and mastery of factual
information?
Motivational Characteristics
1.
4.
Does the student show genuine excitement and enthusiasm for
learning?
Is the student able to be self-critical and self-correcting?
Does the student handle outside responsibilities as well as school
demands?
Is the student intellectually playful, curious, and imaginative?
5.
Is the student self-confident and emotionally secure?
2.
3.
Never
Seldom
Sometimes
Usually
Always
Comments: ___________________________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
THIS RECOMMENDATION IS CONFIDENTIAL
All parts of the application are due to Jefferson County Schools MYP Programme, 2100 18th Street South, Birmingham, AL 35209, by March 26, 2015.