The Governor's School @ Innovation Park - Student Application Packet Prince William County Public Schools 2021-22
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The Governor’s School
@ Innovation Park
Student Application Packet
Prince William County Public Schools
2021-22
Website:
https://governors.pwcs.edu
For more information, contact
Karima Wesselhoft
Supervisor, Advanced Academic & Specialty Programs
14715 Bristow, Rd., Manassas, VA 20112
703-791-7400
wesselka@pwcs.edu
Prince William County Public Schools (PWCS) does not discriminate in employment or in its educational programs, services, and activities on
the basis of race, color, religion, national origin, sex, gender identity, sexual orientation, pregnancy, childbirth or related medical conditions,
age, marital status, veteran status, disability, genetic information, or any other basis prohibited by law. The following individual will handle
inquiries regarding nondiscrimination polices, including Section 504 and Title IX:
Associate Superintendent for Human Resources
Prince William County Public Schools, P.O. Box 389, Manassas, VA 20108
I
DO NOT RETURN THIS PAGE WITH YOUR APPLICATION
FOR YOUR REFERENCE ONLY
Program Overview and Application for Admission 2021-22
Application Due Date: February 1, 2021
Program Description:
The Governor’s School @ Innovation Park offers selected juniors and seniors from Manassas City, Manassas Park, and Prince
William County an advanced and intensive program in STEM – science, technology, engineering, and mathematics. Students selected
to attend the two-year program will attend classes at George Mason University’s Prince William Campus each morning. At that
campus, students will follow a sequence of courses designed to integrate mathematics and research with specializations in biology,
chemistry, or physics. Students will select which strand (biology, chemistry, or physics) they wish to pursue for the two-year study.
Along with specifically designed coursework in that strand, students will be provided intensive study in mathematics that supports
their scientific and research endeavors. Students will be placed initially in Advanced Mathematics Models or Calculus I based upon a
mathematics assessment on February 27 and February 28, 2021. Students return to their base high schools each afternoon to complete
other requirements for graduation.
A unique feature of the program is–– its emphasis on research. All students will come together in certain STEM electives to design
and conduct original research. Students, working across strands, will integrate their knowledge and perspectives to design, conduct,
and report their research exactly as scientists at major universities, such as GMU, do. To help students understand the importance of
their research and the engineering applications of their learning, each student will complete a mentorship working with STEM
professionals on specific projects.
As a continuously accelerated model, only rising juniors may enter this program. Applicants must be aware that participation in this
program carries with it the expectation that registration for courses at their base high school will be restricted. It is strongly
recommended that they take the following courses prior to applying for GS@IP:
Science Mathematics Requirement Electives
Required Required Recommended
Biology (pre-AP level, Algebra I, Geometry Three years of one language
or pre-IBDP level, or IGCSE level
recommended)
Required Required (or currently enrolled) Recommended
Chemistry (pre-AP level, Algebra II/Trigonometry Economics and Personal Finance
or pre-IBDP level, or IGCSE level
recommended)
Recommended Recommended Recommended
Physics Precalculus w/Trigonometry for AB Fine or Practical Art
or Precalculus for BC
Admissions Process:
Students’ potential to succeed in the GS@IP program will be assessed through a variety of means, including, but not limited to PSAT
scores, GPA & teacher recommendation. No single assessment disqualifies a student from review. Each school division makes its own
decisions about eligibility, but all three school divisions use the same criteria and application process. Students found eligible by the
school system must be vetted by George Mason University before final acceptance into the program.
Students should complete the full application and submit the signed document to Karima Wesselhoft no later than February 1, 2021.
County Contact Person Contact Information
703.791.7400
wesselka@pwcs.edu
Prince William County Karima Wesselhoft
Public Schools Supervisor of Advanced Academic & Specialty Programs Student Learning /Karima Wesselhoft
Kelly Leadership Center
14715 Bristow, VA 20112
Students who have been accepted into the Governor’s School program are required to attend a new student orientation the week before
the Governor’s School classes on the George Mason University Science and Technology Campus start in August 2021.
ii
DO NOT RETURN THIS PAGE WITH YOUR APPLICATION FOR YOUR REFERENCE
ONLY
Application Information
The following information is collected and reviewed for each applicant:
▪ Career Highlights – Each applicant must indicate activities, participation in organizations, and awards and
honors.
▪ Portfolio and Portfolio Reflection – Each applicant must be complete a portfolio to demonstrate interest and
ability in science, technology, engineering, and/or mathematics.
▪ Written Essays – Each applicant must complete one essay and submit the essay with the application. The second
essay will be completed in a timed, controlled setting on Friday, February 20, 2021 (4 – 6 pm) or Saturday,
February 21, 2021 (10 am – 2 pm) at the Kelly Leadership Center, 14715 Bristow Road, Manassas.
▪ Recommendations – Each applicant must request recommendations from current science and mathematics
teachers and from one other adult.
▪ Testing Information – PSAT, SAT, or other aptitude measures will be administered as needed by the separate
school divisions.
▪ Grade Point Average – Each applicant’s Grade Point Average will be calculated on an unweighted scale for
science, technology, engineering, and mathematics courses only. Students are also required to have an over-all
GPA of 3.4 or higher for entry into George Mason University
▪ Official Transcript - An official transcript will be added to the student application after is has been submitted for
review.
George Mason University Admission Process
Students selected to attend The Governor’s School @ Innovation Park must be eligible for admission as a special
Guest Matriculate Student at George Mason University (GMU). The university reviews each student’s official high
school transcript.
▪ Students need to have taken or be taking all pre-requisite mathematics and science courses with successful
mastery of course content.
▪ Students should have an over-all GPA of 3.4 or higher.
▪ Students should rank in the top quarter of the class.
Important Dates in the Application Process
▪ GS@IP Information Session- Date and Time to Be Determined
▪ February 1, 2021, Monday- Student applications due to Karima Wesselhoft, Supervisor of Advanced
Academics & Specialty Programs.
▪ February 13, 2021, Saturday – Math exam review session, GMU Science & Tech Campus, Manassas
▪ February 20, 2021, Friday (4 – 6 pm) or Saturday, February 21, 2021, Saturday (10 am – 2 pm) – REQUIRED In-
person timed essay writing for all applicants, Kelly Leadership Center, 14715 Bristow Road, Manassas
▪ February 27, 2021, Saturday (9 am), or February 28, 2021, Sunday (9 am) – REQUIRED Math Content
Examination, Prince William Campus, GMU
▪ April 5, 2021, Monday – Decision letters emailed to students
▪ April 16, 2021, Friday – Students’ deadline to confirm acceptance and attendance
iii▪ May 1, 2021, Saturday – REQUIRED GS@IP welcome meeting with information on the GMU application
process
▪ May 14, 2021, Friday – Deadline to apply for admission and G-number through online GMU guest
matriculation
▪ May 29, 2021, Saturday – REQUIRED new student/parent information meeting
▪ August 20, 2021, Friday (8a.m.) - REQUIRED new student orientation prior to the start of the regular GS@IP
school year begins
▪ August 23, 2021, Monday – GS@IP classes begin on GMU Science and Tech Campus, Manassas
ivDO NOT RETURN THIS PAGE WITH YOUR APPLICATION FOR YOUR REFERENCE
ONLY
INFORMATION PAGE
Checklist for Completed Application:
Read and follow all directions to complete the application fully, clearly, and legibly.
Include all information requested on applicant information, including applicant signature at
bottom. (Page 1)
Complete the Career Highlights section. (Page 4)
Request recommendations from a science teacher, a mathematics teacher, and another
adult. (Pages 5, 6, 7)
Sign and date Program Expectations. (Applicant – Page 8-9)
Sign and date Program Expectations. (Parent – Page 8-9)
Create a portfolio demonstrating your interest and ability in science, technology,
engineering, and/or mathematics. Be certain to include your portfolio reflection on a
separate sheet of paper.
Complete your 300-500 word essay on a separate sheet of paper.
Check with your school point of contact to make sure that your recommendations have
been returned and your transcript has been attached.
Complete a timed writing assignment as scheduled.
MINIMUM ADMISSIONS REQUIREMENTS
High ability and/or talented rising 11th grade students may submit an application packet, if they will have
successfully completed the following courses and tests by the end of the tenth grade year:*
Successfully completed the following prior to attending GS@IP
Algebra II/Trigonometry
Algebra I and Geometry
Biology and Chemistry – pre-AP level, or pre-IBDP level, or IGCSE level are recommended
Pre-Calculus (Engineering)
Physics (Engineering)
PSAT or SAT (Due to COVID-19, students will not be penalized if they were unable to take the PSAT or
SAT. However, if you have taken either test, we will use your scores to help evaluate you application.)
*Interested students who do not meet the above criteria must provide a letter of explanation with application.
v2021-22 GS@IP Application
APPLICANT INFORMATION: Provide all requested information.
Personal Information
Last Name Street Address
First Name City, ZIP Code
Middle Name Home Telephone
Nickname Gender
Student’s email
Date of Birth Student’s cell
phone
Parent 1 email
Name of Parent
Parent 1 cell
1 or Guardian
phone
Parent 2 email
Name of Parent
Parent 2 cell
2 or Guardian
phone
District and School Information:
School Division Prince William County High School
Point of Contact Karima Wesselhoft Contact email wesselka@pwcs.edu
If the student is a transfer student into the School Division, please indicate the name and address of the school from which the
recommendation will be requested.
Teacher or Adult Position
Teacher or Adult Name
Address if Needed
Recommendation
for Mathematics
Recommendation
for Science
Recommendation
from Other Adult
Current Math Course: _____________________________________________________
STUDENT STATEMENT:
The decision to apply for Governor's School is my own. I want to participate fully in the program. If selected, I will abide
by the regulations explained in the program descriptions and all other expectations provided by the program director. The
responses contained in this application are my own work and are truthfully offered.
SIGNATURE OF APPLICANT DATE
___________________________________________________________________________________________________
SIGNATURE OF PARENT DATE
1STUDENT’S NAME _______________________________________
STUDENT PORTFOLIO
The student portfolio is a collection of work produced that will demonstrate your commitment and experience in science,
technology, engineering, and/or mathematics (STEM). All applicants will submit a portfolio which includes these pieces:
1. Research project
2. Academic Essays (Timed/Untimed)
3. Career Highlights: activities and honors
4. Portfolio reflection
The portfolio is rated by STEM teachers, who will determine its strength holistically. Scores include ratings of Average,
Above Average, Excellent, and Superior.
ITEM 1: RESEARCH PROJECT
Students must submit a detailed research project that incorporates all aspects of the research design used in the field.
For reference, students should review the information at the following Web sites:
https://student.societyforscience.org/international-rules-pre-college-science-research. Students should submit both the
oral presentation component (usually in the form of a PowerPoint presentation) as well as the complete written
component of the research project. If the oral presentation has not been given, a PowerPoint that would be given may
be submitted. One (1) copy of the written document must be provided in the student’s portfolio.
Option 1:
Students who have participated in the local, regional, or state Virginia Junior Academy of Science (VJAS) or any level
of the International Science and Engineering Fair (ISEF) competitions may submit their work for those competitions.
Such research must have been completed after the beginning of grade 9 to be eligible for review. Such products must
include both the written documentation of design as well as the display represented for judging. All forms submitted to
the initial competition must be included in this submission for review.
Option 2:
Students may design a new research design which incorporates all aspects of the scientific design. Students must
complete and submit the written and oral presentation components of their design. Students may design their
experiments and collect and evaluate authentic data if time permits. If the data cannot be collected within the
timeframe available, students may create data that are probable within the existing conditions and present summaries
and conclusions around those data. Students choosing option 2 should limit their experiments to questions that do not
require the use of human subjects, recombinant DNA, tissue, pathogenic agents, or controlled substances.
ITEM 2: ACADEMIC ESSAY
All students interested in submitting a Governor’s School application must compose two academic essays. The first essay
will be submitted with the student’s application; the second essay will be completed in a timed, controlled setting either
Friday, February 20, 2021 (4 – 6 pm) or Saturday, February 21, 2021 (10 am – 2 pm) at the Kelly Leadership Center,
14715 Bristow Road, Manassas.
Requirements for the Essay:
Essay # 1 (to be submitted with the student application) - Write your answer to the following essay question on a separate
sheet(s) of paper and submit it with your final application. Your response should be no more than two double-spaced
pages - 12-point type, Times New Roman font - 1” margins. Make sure your name is included in the upper right-hand
corner of each page of the essay.
2Essay # 1: Prompt (untimed)
The Governor’s School @ Innovation Park offers students an opportunity to explore the world of STEM through
the lens of Biology, Chemistry, or Physics. In a well-formed essay, please indicate which of these three areas of
study interests you more than the others. In your response make sure to explain:
1) Why this branch of science is of greatest interest to you,
2) What efforts you have already made to expand your understanding in this branch of
science,
3) How focused study in this branch of science relates to your future goals.
Essay #2: Prompt (timed)
Friday, February 20, 2021 (4 – 6 pm) or Saturday, February 21, 2021 (10 am – 2 pm) at the Kelly Leadership Center,
14715 Bristow Road, Manassas.
Applicants should review the rubric on this page and consider each of the areas carefully as they begin thinking about the
writing process for their essays.
Composition 0 1 2 3 4
Missing/
Central Idea Weak Moderate Strong Insightful
Unclear
Elaboration Unclear Seldom Some Appropriate Persuasive
Organization Lacking Random Lapses Logical Convincing
Many
Unity Absent Some digression Unified Purposeful
digressions
Vibrant/persuasiv
Voice Silent Absent Weak Controlled
e
Mechanics 0 1 2
Sentence Structure Weak Some variety Varied
Usage Incorrect Some incorrect Consistently correct
Mechanics Incorrect Some incorrect Consistently correct
3STUDENT’S NAME _________________________________________
ITEM #3: CAREER HIGHLIGHTS - ACTIVITIES AND HONORS
In the sections that follow, list accomplishments that highlight your positions of leadership or academic and intellectual
activities.
ACTIVITIES/PROGRAMS
List the three most significant activities/programs in which you have participated during the past three years that relate to science,
technology, engineering, and/or mathematics. Include the name of the organization, sponsoring agency, or group. Also, describe the
time involved and any leadership position you have held. Under “Year” indicate the calendar year of the training or activity. If you
need more space, attach a second sheet. Please explain any acronyms that you use.
Activity and Organization Position(s) Held Time Involved Year
Example:
Science Club Vice President 6 hours/week 2018-19
1. 1.
2. 2.
3. 3.
HONORS/RECOGNITIONS
In this section, please list the three most significant honors/recognitions you have received during the last three years in your area of
interest.
Level of Competition – Regional,
Honors/Recognitions Year
State, National, etc.
Example:
First Place, Regional Science Fair Regional 2019
1. 1.
2. 2.
3. 3.
ITEM 4: PORTFOLIO REFLECTION
Students must include a written reflection for the portfolio as a whole that indicates why the submitted works are
examples of his or her best reasoning, communication skills, maturity, and commitment to scientific research and study.
The reflection is included in the assessment of the portfolio by the committee. Please complete this reflection on a
separate sheet of paper. Include the reflection with your portfolio. Please use 12-point type; Times New Roman font; 1”
margins; and include your name in the upper right-hand corner of the reflection.
4STUDENT’S NAME __________________________________
ACADEMIC/MENTORSHIP TEACHER RECOMMENDATION – SCIENCE:
This recommendation must be made by the student’s current science teacher, preferably a teacher who has taught the
student in a course closely related to the selected program. Please complete both the Rating Scale and the Teacher
Narrative (attach an additional page if necessary).
RATING SCALE:
1. What course or program of studies has the student taken under your supervision? In what year(s)?
2. Please estimate the extent to which the student has demonstrated in your class(es) the qualities listed below. Use the
scale from 0-2 as indicated. Be sure to respond to all qualities; items omitted are included as a zero when computing a
score. Please use only whole number values.
0=Good (Above Average) 1=Excellent (Top 10%) 2=Outstanding (Top 2-3%) SCORE
1. Motivation and initiative
2. Self-direction
3. Intellectual curiosity
4. Independence of thought
5. Originality of ideas
6. Use of higher-level thinking skills
7. Ability to contribute to a group process
8. Willingness to accept ideas of others
9. Emotional stability, maturity, and self-discipline
10. Openness to new experiences
11. Cooperative behavior
12. Respect and tolerance for the views of others
Subtotal – SCIENCE (out of 24)
NARRATIVE: Please use the space below to provide any additional insight you may have regarding the student’s strength
as a qualified candidate for The Governor’s School @ Innovation Park.
Instructions for Submitting the Science Teacher Recommendation
Please sign and date this document and return it directly to Karima Wesselhoft, Supervisor of Advanced Academic &
Specialty Programs at the Kelly Leadership Center. Once you have completed your letter of intent to apply, you will
receive a link to a Onedrive file. You may scan and upload all documents to the file. All documents must include your
name and student number. For questions, please contact Karima Wesselhoft – wesselka@pwcs.edu
Teacher’s Name Signature Date
High School Phone Number Email Address
5STUDENT’S NAME __________________________________
ACADEMIC/MENTORSHIP TEACHER RECOMMENDATION – MATHEMATICS:
This recommendation must be made by the student’s current mathematics teacher, preferably a teacher who has taught the
student in a course closely related to the selected program. Please complete both the Rating Scale and the Teacher
Narrative (attach an additional page if necessary).
RATING SCALE:
1. What course or program of studies has the student taken under your supervision? In what year(s)?
2. Please estimate the extent to which the student has demonstrated in your class(es) the qualities listed below. Use the
scale from 0-2 as indicated. Be sure to respond to all qualities; items omitted are included as a zero when computing a
score. Please use only whole number values.
0=Good (Above Average) 1=Excellent (Top 10%) 2=Outstanding (Top 2-3%) SCORE
1. Motivation and initiative
2. Self-direction
3. Intellectual curiosity
4. Independence of thought
5. Originality of ideas
6. Use of higher-level thinking skills
7. Ability to contribute to a group process
8. Willingness to accept ideas of others
9. Emotional stability, maturity, and self-discipline
10. Openness to new experiences
11. Cooperative behavior
12. Respect and tolerance for the views of others
Subtotal – MATHEMATICS (out of 24)
NARRATIVE: Please use the space below to provide any additional insight you may have regarding the student’s strength
as a qualified candidate for The Governor’s School @ Innovation Park.
Instructions for Submitting the Science Teacher Recommendation
Please sign and date this document and return it directly to Karima Wesselhoft, Supervisor of Advanced Academic &
Specialty Programs at the Kelly Leadership Center. You are welcome to scan the document and email it as an attachment
– wesselka@pwcs.edu.
Teacher’s Name Signature Date
High School Phone Number Email Address
6STUDENT’S NAME ______________________________________
ANOTHER TEACHER/ADULT RECOMMENDATION:
This recommendation must be made by one of the student’s current teachers or other adult, preferably a teacher who has
taught the student in a course closely related to the selected program. The recommendation should not be completed by a
parent or other relative. Please complete both the Rating Scale and the Teacher Narrative (attach an additional page if
necessary).
RATING SCALE:
1. What course or program of studies has the student taken under your supervision? In what year(s)?
2. Please estimate the extent to which the student has demonstrated in your class(es) the qualities listed below. Use the
scale from 0-2 as indicated. Be sure to respond to all qualities; items omitted are included as a zero when computing a
score. Please use only whole number values.
0=Good (Above Average) 1=Excellent (Top 10%) 2=Outstanding (Top 2-3%) SCORE
1. Motivation and initiative
2. Self-direction
3. Intellectual curiosity
4. Independence of thought
5. Originality of ideas
6. Use of higher-level thinking skills
7. Ability to contribute to a group process
8. Willingness to accept ideas of others
9. Emotional stability, maturity, and self-discipline
10. Openness to new experiences
11. Cooperative behavior
12. Respect and tolerance for the views of others
Subtotal – OTHER AREA (out of 24)
NARRATIVE: Please use the space below to provide any additional insight you may have regarding the student’s strength
as a qualified candidate for The Governor’s School @ Innovation Park.
Instructions for Submitting the Science Teacher Recommendation
Please sign and date this document and return it directly to Karima Wesselhoft, Supervisor of Advanced Academic &
Specialty Programs, Kelly Leadership Center (14715 Bristow Rd., Manassas, VA 20112). You are welcome to scan the
document and email it as an attachment – wesselka@pwcs.edu
Teacher’s Name Signature Date
High School Phone Number Email Address
7STUDENT’S NAME ______________________________________
PROGRAM EXPECTATIONS LAS EXPECTATIVAS DEL PROGRAMA
Both student and parent/guardian must initial after having read the following assurances. These constitute the
expectations for students who accept invitations to GS@IP.
El estudiante y el padre/guardián tienen que poner las iniciales de su nombre después de haber leído las
siguientes garantías. Estas constituyen las expectativas para los estudiantes que aceptan la invitación de GS@IP.
Student Parent or
Initials Guardian
Iniciales Initials Expectations
del Iniciales Expectativas
estudiante del padre/
guardián
I understand that the programs require concerted academic focus, preparation, and
motivation from all participants and that participants are expected to demonstrate the
emotional maturity and self-discipline to participate in the activities and to demonstrate
respect for self, others, program, and school.
Entiendo que los programas requieren un enfoque académico, preparación, y motivación
de todos los participantes y que los participantes tienen que demostrar la madurez emocional
y la disciplina interna para participar en las actividades y demostrar el respeto de sí mismo,
otros, el programa y la escuela.
I certify that I am a resident of the Commonwealth of Virginia and eligible for a free,
public education in a public school in Prince William County, Manassas City, and Manassas
Park City Schools.
Certifico que soy residente del Estado de Virginia y tengo derecho a la educación
pública gratuita en una Escuela Pública del Condado de Prince William, la Ciudad de
Manassas y la Ciudad de Manassas Park.
I understand that my application is due to Karima Wesselhoft Supervisor of Advanced
Academic & Specialty Programs by Monday, February 1, 2021.
Entiendo que mi solicitud se debe al Karima Wesselhoft Supervisor de Educación para
Programas Académicos Avanzados y Programas Especiales para el lunes, 01 de febrero
2021.
I understand that I am required to take a mathematics test on Saturday, February 27,
2021, or Sunday, February 28, 2021. I understand that this mathematics assessment is a
required component of the admissions process.
Entiendo que tengo la obligación de tomar una prueba de matemáticas en sábado, 27 de
febrero 2021, o domingo, 28 de febrero 2021. Entiendo que esta evaluación de
matemáticas es un componente necesario del proceso de admisión.
I understand that each division coordinator will email acceptance letters on
April 5, 2021, and that no information on acceptance will be available before that date.
Entiendo que cada división coordinador de educación para superdotados le enviará las
cartas de aceptación el 5 de abril 2021, y que no hay información sobre la aceptación
estarán disponibles antes de esa fecha.
I understand that, if accepted, I will submit an electronic application to George Mason
University by Friday, May 14, 2021.
Entiendo que si me aceptan, entregaré electrónicamente mi solicitud de ingreso a la
Universidad de George Mason antes del viernes, 14 de mayo de 2021.
I understand that, if accepted, I will be considered a Guest Matriculate Student at
George Mason University. I understand that I am responsible for abiding by university
procedures regarding course registration, academic studies, and conduct.
Entiendo que si me aceptan, seré considerado/a un(a) Estudiante Temporalmente
Matriculado en la Universidad de George Mason. Entiendo también que debo cumplir con
los procedimientos de la universidad en cuanto a la matrícula para cursos, los estudios
académicos, y la conducta.
8Student Parent or
Initials Guardian
Iniciales Initials Expectations
del Iniciales Expectativas
estudiante del padre/
guardián
I understand that the GS@IP calendar could be different from my home school calendar.
GS@IP students are required to attend school on all scheduled days.
Entiendo que el calendario de GS@IP puede ser diferente del calendario escolar de mi
casa. Los estudiantes de GS@IP tienen que asistir a la escuela en todos los días planeados.
I understand that the cost of participation per student is paid by the participating school
division. I take this commitment seriously and recognize that we may be required to
reimburse the school division for the cost if our son/daughter chooses to leave the program
before graduation.
Entiendo que el costo de participación por alumno es pagado por la división escolar. Yo
tomo este compromiso seriamente y reconozco que puede que tengamos que reembolsar a la
división escolar el costo del programa si nuestro hijo/a se retira voluntariamente del
programa antes de la graduación
I understand that tuition costs for optional dual enrollment courses in which I choose to
enroll are not covered by my school division, I agree to pay the balance in full and abide by
George Mason University’s registrar calendar for add/drop and payment due dates.
Entiendo que los costos de la matrícula doble opcional que he escogido no son pagados
por la división escolar. Me comprometo a pagar el saldo pendiente por completo y cumpliré
con las fechas límites en cuanto al pago de los costos y las fechas para añadir o salir de
cursos (“add/drop” ) del calendario de George Mason.
I have discussed graduation requirements with my parents and my school Point of
contact; I am aware of the coursework/credits I must successfully complete for the diploma I
wish to pursue.
He analizado los requisitos de graduación con mis padres y con la persona encargada en
mi escuela, estoy consciente de los cursos y créditos que debo completar con éxito para
recibir el diploma que deseo obtener.
I certify that these are my truthful responses to these expectations.
Certifico que éstas son mis verdaderas respuestas a estas expectativas.
TO BE COMPLETED BY APPLICANT - The decision to apply to the Governor's School is my own, and I want to
participate fully in the program. The responses contained in this application are my own work. I have read in its entirety
the application procedures, including the application forms, program expectations, and am aware of my school division’s
appeals process.
_________________________________________________________________________ Date: ________________
Printed Name and Signature of Applicant
TO BE COMPLETED BY PARENT/GUARDIAN PARA SER COMPLETADO POR EL PADRE/GUARDIÁN
I, the parent/guardian of the student above, am aware of and in support of the student's application to GS@IP and give
permission for the student's academic records to be reviewed by the division's selection committee. I have read in its
entirety the application procedures, including the application forms, program expectations, and am aware of my school
division’s appeals process.
Yo, el padre/guardián mencionado anteriormente, soy consciente de y apoyo la solicitud del estudiante a GS@IP y doy
mi permiso para que el expediente académico de mi hijo/a sea revisado por el comité de selección de la división escolar.
He leído en su totalidad los procedimientos de solicitud, incluso los formularios de solicitud y las expectativas del
programa, y estoy consciente del proceso de apelaciones de mi división escolar.
____________________________________________________________________________ ____________________
Printed Name and Signature of Parent/Guardian Date
Nombre en letra molde/imprenta y firma del Padre/Guardián Fecha:
9GOVERNOR’S SCHOOL APPLICATION SCORES PAGE STUDENT NAME:_____________________________________________
I. Research Project and Portfolio Reflection
Indicate the consensus score given to project and reflection by the committee.
Portfolio Assessment
Superior 10
Excellent 9
Above Average 8
Average 7
(Score x 2) = (20 max)
II. Essay Evaluation: (1 and 2)
Essay #1: Reader One: ___ 6 ___ 5 ___ 4 ___3 ___2 ___1 Reader Two: ___ 6 ___5 ___4 ___3 ___2 ___1
Essay #2: Reader One: ___ 6 ___ 5 ___ 4 ___3 ___2 ___1 Reader Two: ___ 6 ___5 ___4 ___3 ___2 ___1
TOTAL II: Reader 1 (Essay #1 + Essay #2) + Reader 2 (Essay #1 + Essay #2) / 2 = (12 max)
III. Career Highlights: Activities, Research, and Honors:
Activity/Program ____ (6 max)
Honor/Recognition ____ (6 max)
TOTAL I: (____ Activities) + (____ Honors) x 2 = (24 max)
IV. Teacher Recommendations:
Rating Scale (max 24 points for each teacher):
___ Math Teacher ___ Science Teacher ___ Other Teacher/Adult
TOTAL III: (____Math Teacher + ___ Science Teacher + ___ Other Teacher/Adult divided by 3) = (24 max)
V. Applicant Aptitude or Achievement Test Score, and Unweighted GPA in STEM Coursework only
Mark the correct response in each category. Include test information below. Use scale (9 - 4) to assign points to each category.
Test ___________________________________ Date Administered ____________________________________
Measured Ability OR Measured Achievement and Unweighted M/S/T GPA
(99-98%) (94-90%) (84-80%)
10 8 6
4.0-3.92 3.83-3.68 3.51-3.44
(97-95%) (89-85%) (You can also read
