METRO NASHVILLE PUBLIC SCHOOLS
MIDDLE COLLEGE HIGH SCHOOL
at Nashville State Community College
120 White Bridge Road
Nashville, Tennessee 37209

APPLICATION FOR ADMISSION School Year 2008-09

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Student's Name: Sex: Male Female Address: Zip: Age (as of 09/01/08) Date of Birth: Home Phone:  Enter a valid phone number. Example: 123-456-7890 Social Security#: Student's Cell Phone:  Enter a valid phone number. Example: 123-456-7890 Student's E-mail:  Enter a valid email address. Example: name@company.com Current School: Current Grade: Parent/Guardian Address: Parent's Work Phone:  Enter a valid phone number. Example: 123-456-7890 Parent's Cell Phone:  Enter a valid phone number. Example: 123-456-7890 Parent's Place of Employment: Parent's E-mail:  Enter a valid email address. Example: name@company.com MNPS Middle College High School is a collaborative agreement between the Metropolitan Nashville Public School System and Nashville State Community College. In addition to academic courses taken for high school graduation, students will select community college courses that can lead to associates' degrees, technical certificates or general core courses that may lead to bachelors' degrees. The college environment encourages students to take ownership and responsibility for their educations. How did you find out about MNPS Middle College High School? (Check all that apply.) Counselor Teacher Principal Web Site Parent/Guardian Friend Other Answer Yes or No to the following questions: 1. Do you currently use a planner to keep yourself organized? Yes No 2. Do you currently want to take college level courses? Yes No 3. Are you currently receiving any Section 504 accommodation or special education services designated through an IEP? Yes No 4. Have you taken the ACT or SAT? ACT score_____ SAT score_____ Yes No 5. Are you prepared and willing to make a commitment to completing the program at the Middle College High School? Yes No Please describe your high school experience, including your involvement in any programs, clubs, activities, etc. What classes would you be interested in taking at Nashville State Community College? What subjects are easy for you? Which subjects are difficult? Are you sent to the office frequently for disciplinary referrals? If so, explain. What will your current principal say about your overall behavior in school? What would your principal and your teachers say about your academic habits? Think about your favorite teacher in your current school. What traits would that person say best describe you? Name one person in your life who best exemplies your meaning of the word "trust" and explain why? How do you feel about attending school on an adult/college campus? MNPS Middle College High School and Nashville State Community College offer a rigorous academic curriculum, which will require you to demonstrate a high level of commitment, maturity, and responsibility. We expect you to demonstrate student behaviors that will ensure that you have an optimal opportunity for success. Tell us how you will balance the freedoms of the college campus (such as no bells, less supervision, freedom to leave campus for lunch, and flexible scheduling) with the responsibilities of the academic program? What have you done in the last six months that would indicate or demonstrate that you take responsibility for your actions? Parent/Guardian Signature: Date: STUDENT/PARENT SIGNATURES AND AGREEMENT Our signatures below certify to the best of our knowledge that all information provided in this application is accurate and complete. Also, if selected to attend Middle College High School, we agree to follow all the rules and regulations of Metro Nashville Public Schools, Nashville State Community College and MNPS Middle College High School at all times. Student Signature: Date This application is not complete until we have a copy of your transcript, Gateway and ECO Tests, TCAP scores, attendance record and two letters of recommendation (from a teacher, counselor, principal, etc.)