ASHLAND UNIVERSITY INTENSIVES 2007 STUDENT APPLICATION FORM

Application deadline :__April 13, 2007__Students will be notified of acceptance by

April 27, 2007 Students must return notification of intention to attend by May 11, 2007

Please return to Dr. Jane Piirto / Ashland University INTENSIVES /

Schar College of Education / Ashland University, OH 44805

Phone: 419-289-5379 or 419-289-5273. Email: jpiirto@ashland.edu, or gvanderz@ashland.edu

Note: Open only to Ohio residents who are identified gifted and talented and are this year’s 9th & 10th graders.

GRADE NEXT YEAR________________BIRTH DATE:_______________M___F___ t-shirt size (circle) S, M, L, XL, XXL

STUDENT NAME_____________________________________SOCIAL SECURITY #:_____________________ ADDRESS______________________________________________ COUNTY OF RESIDENCE_____________________

 STREET OR P.O. BOX CITY STATE ZIP EMAIL ADDRESS___________________________________

HOME PHONE (______)______-__________ SCHOOL PHONE (______)______-____________

SCHOOL NAME_________________________________DISTRICT NAME __________________________

SCHOOL ADDRESS_________________________________________ Please Circle: Rural - Urban - Suburban

                                   STREET OR P.O. BOX CITY STATE ZIP  

ETHNICITY (Please Circle) African Am- Asian Am- Native Am- European Am- Hispanic Am Other

How did you find out about the Institute? (Circle) School Counselor - Teacher- Mailing- Gifted Coordinator- Newspaper-Other (describe)____________________________________________________________________________________________

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CHOICE OF SEMINAR: Put numbers 1 or 2 for 1st and 2nd choices. You may attend either or both Week One and Week Two.

Week One: July 8 to July 14, 2007

Week Two: July 22-28, 2007

APPLICATION CHECKLIST: Your application will be returned to you for missing items if all of these are not checked and included.

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______ 1. Please have an official from your school district fill out the enclosed form.

______ 2. Please submit a 500 (at least) word double-spaced typed personal essay on the topic, (1) “Intellectual Insights I Have Had” or (2) “Why I Want To Study In This Seminar.”

______ 3. Please submit a letter from an adult in your school or community (not a relative) who knows you, recommending you for this intensive.

______ 4. Please submit a copy of your grades for the last year, and of your most recent standardized test scores.

______ 5. Enclose a $5.00 deposit fee. Check made payable to Ashland University

                Note: Room and Board is $345.00($5.00 deposit+$340.00) for 7 days. This is payable upon arrival. For scholarship assistance, have parents or guardian send a letter explaining your need to Dr. Jane Piirto /Director of Summer Honors Institute for Gifted Students/ Ashland University/Ashland, OH 44805. No charge for commuters. Lunch included. The $5 application fee will be refunded upon arrival. Ashland. Ashland University admits students with disabilities and those of any sex, race, age, color, and national or ethnic origin.

Student Eligibility Confirmation Form

Ohio Summer Honors Institutes

Instructions to Students:

This form must be completed and signed by a gifted education coordinator, gifted education teacher, guidance counselor, principal or psychologist. Submit the completed and signed form with your application to the Summer Honors Institute to which you are applying. If you are applying to attend a Summer Honors Institute at more than one college or university, photocopy this form and submit completed and signed copies to each Summer Honors Institute.

If you are not currently enrolled in an Ohio public school, you may demonstrate eligibility by submitting documentation showing that you meet the criteria for gifted identification in Ohio Administrative Code (OAC) 3301-51-15(c) (“eligibility”) in place of this form. The text of OAC 3301-51-15 is available online at:

www.ode.state.oh.us/exceptional_children/gifted_children/TheRuleOAC3301-51-15.ASP

A parent or guardian’s signature is not sufficient to establish eligibility to participate in a Summer Honors Institute.

Instructions to Educators:

To be eligible to participate in the Ohio Summer Honors Institutes, students must be enrolled in the ninth or tenth grade during the 2005-2007 academic year, and must be identified as gifted in one or more areas of identification according to the criteria specified in Ohio Administrative Code (OAC) 3301-51-15.

The text of OAC 3301-51-15 is available online at:

www.ode.state.oh.us/exceptional_children/gifted_children/TheRuleOAC3301-51-15.ASP

Please complete, sign, and date this form.