RSA Application 2021 – Rising Scholars Academy

Name - Nombre *

First

Middle

Last

Gender - Identidad *

Female
Male
Trans Female
Trans Male
Gender-Queer / Non Conforming
Different Identity

Date of Birth - Fecha de Nacimiento *//

Current School - Escuela *

School Name - Nombre de Escuela

Current Grade Now - Grado actual *

Course Selection - Clase Preferida *

1st Choice - Primera Opcion

Second Choice - Segunda Opcion *

2nd Choice - Segunda Opcion

Third Choice - Tercera Opcion *

3rd Choice -Tercera Opcion

Please write a cover letter to accompany your application, 200 word minimum, explaining your reasons for choosing each of the courses you have chosen. In your (the student’s) own words, include information about your interest in the subject(s), what you hope to learn, and related experience, if any. If the course(s) you list have prerequisites, mention how you have met them. Remember, this letter should be about YOU and your personal interest & qualifications, not about the relevance of the course(s) in general. *

We strongly recommend that you first compose your letter elsewhere (such as Microsoft Word or an online Google Doc), save a copy for your records, and then copy and paste it here once you're done. 4200 Character Limit

Teacher Recommendation

This form must be completed by a teacher who is currently teaching you in an academic subject (e.g. mathematics, science, languages arts, etc.). The subject need not match the subject of the ATDP course to which you are applying. Remember that your teacher's time and attention are valuable. Please ask your teacher for their permission before including them in your application below. We recommend asking your teacher at least one week before you plan to submit it with your application so that your teacher has time to complete the Teacher Recommendation Form. You will not be able to submit your application until your teacher completes the form.

Subject / Type of Teacher *

History
English
Math
Foreign Language
Science
other AP

Teacher's Name *

First

Last

Teacher Email *

Important: Ensure that your teacher's email address is correct, and that you have obtained their permission. Note that some school email systems have strict security and my not be reachable by our application system. If the email is not received, print a paper form for your teacher to complete instead.

Report Card

Submit a legible photocopy of your first semester (or most recent) report card for the current (2020-2021) school year.

We request that you send final grades, but if those are not available, you may submit your most recent progress report. Do not delay submitting your application to wait for final grades; if necessary, we may ask for an updated report card after receiving your application. If your school does not issue letter grades, please submit whatever report is on record. If you need assistance obtaining a copy, contact your school office.

Please do not include certificates or awards.

Transcript Upload

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Upload a PDF, JPG, or PNG

Achievement Test Scores

Include a legible photocopy of your most recent California standardized test (CAASPP) or other standardized achievement test scores (e.g., Stanford Achievement Test, Iowa Test of Basic Skills, or other school-administered test that gives national percentile scores). The test must have been taken within the past three years (i.e. 2020, 2019, or 2018) and include scores in the areas of math and reading/ELA. College Board SAT/PSAT scores are not accepted for this application item.

Do not delay submitting your application to wait for more recent test scores. Include whatever acceptable test scores you have from the last three years.

If you have not taken a standardized achievement test in the past three years, submit a signed note with a school stamp from an administrative staff person at your school indicating so.

Test Score Upload

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PDF, JPG, PNG

Academic Product or Essay

Please submit an academic product that meets the criteria of one of the following three options (A, B or C). This work should be one of which you are especially proud and which was completed since September 2020. While the work may have been done for a school assignment, it need not have been. The product you submit need not be in the same subject area as that to which you are applying, but keep in mind that the written component must develop your own original thinking beyond restating facts.

• Option A - Existing Essay or Story - Submit an essay or story of at least 500 words that shows your original thought and that is long enough for you to develop your ideas. A social studies or science report is not appropriate unless it relies heavily on your own analysis in addition to reporting factual information.

• Option B - Write an Essay - Write a well-developed essay of no more than 1,500 words on one of the topics below. You may type or write in ink on lined paper. Take time to consider the topic in depth and organize your answer. Be sure to title your essay.

o If you could implement a new public health initiative now or in the future, what would it be and why? Your idea can be anything that helps to improve health, safety, or wellbeing in your community. When should your plan be implemented and who would benefit from it? Present your proposal in well-reasoned and organized paragraphs with supporting evidence.

o Write about something you’ve read that changed your opinion on a topic. How did you encounter this piece of writing, and what was compelling about it? Were you most moved by the content, format, or writing style, or did these components work together to have an impact? End your essay with one or more recommendations you would have for someone who is interested in learning about this topic.

• Option C - Other Existing Product - If you’d like to submit documentation of a piece of academic work that deviates from a traditional essay or story format (e.g., art, poetry, computer programs, and science experiments), you must also submit a clear, well-developed explanation of your work. Your written explanation should be at least 500 words and must be long enough to clearly demonstrate your thinking as you developed this product.

Product or Essay Upload

Click or drag files to this area to upload. You can upload up to 5 files.

PDF, JPG, PNG

Student Contact Info

Please provide your current address where you will be able to receive mailed correspondence.

Address - Domicilio *

Address Line 1

Address Line 2

City

State

Zip Code

Student Email - Correo Electronico de Estudiante *

Cell Phone - Telefono Cellular

Parent/Guardian Contact

Please supply the name of the parent or guardian who will be acting as the primary contact for RSA's application process. (We will ask for other parent and emergency contact information later.)

Name *

First

Last

Parent/Guardian Email - Correo Electronico de Padre/Madre/Guardian *

Primary Phone/Cell *

Work Phone/Cell or other Parent/Guardian

Work Number or other Parent/Guardian Cell

Biographical Data

Your responses in this section will not affect your admission status or course placement.

In order to help us develop a greater base of knowledge about our student population, please complete the questions below.

Ethnic Background (please check any and all that apply:

American Indian / Alaskan Native
African American / Black
Mexican / Mexican American / Chicanx
Chinese / Chinese American
East Indian / Pakistani
Japanese / Japanese American
Korean / Korean American
Latinx / Other Hispanic American
Pacific Islander
Pilipino / Filipino American
Vietnamese/Thai/Other Asian
White/Caucasian (& Middle Eastern)
Other
Decline to state

What language did you first learn to speak? *

English
Spanish
English and Spanish
Another
English and Another

In what country were you born?

If you were born in another country, when did you come to the United States?

Highest level of education completed by your parent(s)/guardian(s)

Father or Parent/guardian #1

Mother or Parent/guardian #2

Current occupation of your parent(s)/guardian(s)

Father or Parent/guardian #1

Mother or Parent/guardian #2

Please indicate the approximate income of your household last year.

Household Income

Financial Aid / Scholarship - Ayuda Financiera / Becas

Upload 2019 Income Tax Report - BLACK OUT SS Numbers!

Click or drag files to this area to upload. You can upload up to 20 files.

Complete Tax Forms (You may black out SS Numbers - Recommended)

Signature - Firma

Student - Parent - Guardian Signature

Student Signature - Firma de Estudiante *

Parent/ Guardian 1 Signature *

Parent/ Guardian 2 Signature

Date / Time *