Application for PACE Program
Scio High School
Updated January 2013
Name __________________________________ Year in School _________________
Career Goal ________________________________________________
Student e-mail Address __________________________________________________
Student Cell Phone Number ______________________
Community College you are planning to attend ________________________________
Parents Names ________________________________________________________
Parents e-mail Address __________________________________________________
Reason for Application:
_____ I will be using personal transportation.
_____ I will be using district transportation.
_____ I understand that this is a pilot project and therefore my personal information may be tracked by the district. Information tracked by the district will be collected individually, but will only be reported in group totals.
College Readiness Class
_____ I understand that I will be required to attend a college readiness class for 30 hours in mid-September.
Financial Aid and Scholarships.
_____I understand that since I will not be graduating from high school, I cannot receive any financial aid or scholarships until I complete the program.
Specialty Equipment, Tuition and Books
_____ I understand that Scio School district is paying the tuition for up to full-time student status. Books will be bought by the district and I will have to return them at the end of the semester or pay for them. If I sign up for a class that requires specialty equipment or supplies, I will be required to provide them.
_____ I understand that I will need to return the textbooks in useable condition and in a timely manner or I will have to purchase them from the district.
_____ I understand that I need prior approval before dropping a class or I will be billed for the cost of the class.
_____ I understand that I will need to successfully complete 12 college credits per term to stay in the PACE program if I am not enrolled in at least one class at Scio High School.
_____ I understand that the student, school district, community college or parent may, without cause, terminate the placement, if it is deemed inappropriate for the student. In such cases the student will be re-enrolled on to the high school campus.
_____ I understand that while placed at the community college, I will have one person as my point of contact. I am also willing to do progress reports as required by the program and return them to that person.
_____ I understand that I have to be making satisfactory progress toward Scio High School’s Advanced Diploma or a pre-approved certificated program, while enrolled in the program.
_____ I understand that this is a pilot program and will change and evolve over time. I will be expected to keep up to date and follow all future program changes.
_____ I understand that in order to stay in the PACE Program, I will need to turn in the provided progress reports at the end of the 4th and 8th week.
_____ I understand that if I do not turn in my progress reports, I will be charged for the tuition and the books.
_____I understand that if I receive a 1098T from the college that I am attending, I may only claim the amount that I paid in tuition on my taxes.
_____ I understand that I will be enrolling into an adult environment and that I am assuming an obligation to conduct myself in a manner compatible with the functions of the college, as an educational institution within a civilized society. There are significant differences between the high school atmosphere and the college atmosphere. For example:
The student population at community college consists primarily of adults who neither need, nor receive supervision from the staff.
The community college staff expects mature, adult-like behavior of all students and do not tolerate inappropriate behavior.
The community college does not provide follow-up on nonattendance; students are expected to attend on a regular basis.
Most students find that the pace in the classroom is significantly accelerated compared to that of high school.
Upon entering the college, students assume responsibility for their actions and for their successes. This includes following all registration processes, meeting deadlines, and seeking assistance for the many services available to students.
Some college classes have special safety standards, which require that the student and parent/guardian read and sign safety guidelines.
Point of Contact
_____ I understand that I will have a liaison that will serve as my point of contact at LBCC and Chemeketa and that I will need to work with him/her on a regular basis.
_____ I understand that there will be mandatory meetings that I have to attend.
_____I do not plan to participate in sports next year.
_____I plan to participate in ________________________________ next year.
Student’s Signature Date
Parent’s Signature Date
----------------------------------------- For Office Use Only ------------------------------------------------
(Minimum 3.0) _____________
_____State Testing and CIM Status
_____ Reading and Literature - Score ________
_____ Writing - Score ________
_____ Work Samples – (3 Required) _______
_____ Mathematics – Score ________
_____ Problem Solving - Score ________
_____ Work Samples – (2 Required) _______
_____ Work Samples – (3 Required) ______________
_____ Science - Score ________
_____ Work Samples – (1 Required) _______
_____ Social Science - Score ________
_____ Mentor Mentee
______ Placement Tests
_____ Mathematics – Placement _____________
_____ Reading - Placement _____________
_____ Writing - Placement _____________
Academic Committee Recommendation
_____ Approved ____ Conditionally Approved ____ Denied Date _______
If Denied or Approved Conditionally
Conditions for Approval or Reasons for Denial
Academic Committee Signature Date