Suffolk Public Schools
International Baccalaureate Program
King’s Fork High School · 351 King's Fork Road ∙ Suffolk, VA 23434
Phone: (757) 923-5240 · Fax: (757) 923-5242
Amy Moncibais, IB Specialist (amymoncibais@spsk12.net)
Student Application
Please complete the application online, save it as your document,
and attach it by e-mail to amymoncibais@spsk12.net.
Applicant Information
Legal First
Name Click here to enter
Legal Last
Name
Middle Name Click here to Date Click
Click here to enter text.
Street Address
here to enter
text.
enter text.
text.
Apartment/Unit # Click here to enter text.
City
Click here to enter text.
State Click here to
Home Phone
Student Cell
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Parent E-mail Address
Student E-Mail Address
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Current Grade Level
Gender
(Male or Female)Click here to enter
Current Middle School
Click
ZIP Click here to enter text.
enter text.
Click here to enter text.
here to enter text.
text.
Mother’s/Guardian’s Full Name
Click here to enter text.
Mother’s/Guardian’s Cell Click here to enter text.
Telephone Number
Father’s/Guardian’s Full Name
Click here to enter text.
Father’s/Guardian’s Cell
Telephone Number Click here to enter text.
Applicant’s Native Language
Click here to enter text.
Applicant’s Zoned High School
Click here to enter text.
Academic Areas of Interest
Rank the following subjects according to your interest from 1 to 6 (1 is the highest, 6 is the lowest). Subjects
may be ranked equally if you wish (more than one ranked as #1).
Foreign Language
Mathematics
Computers
Social Studies
Environmental Science
Art
Psychology
Other Sciences
Theater
Language Arts
Music
Major Awards/Honors, if any (List Below).
Click here to enter text.
Extra-curricular Areas of Interest
Click here to enter text.
International Baccalaureate Program
11/16/15
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Suffolk Public Schools
International Baccalaureate Program
King’s Fork High School · 351 King's Fork Road ∙ Suffolk, VA 23434
Phone: (757) 923-5240 · Fax: (757) 923-5242
Amy Moncibais, IB Specialist (amymoncibais@spsk12.net)
Admissions Agreement
The International Baccalaureate Diploma Program is a rigorous, comprehensive program designed for the academically
motivated student with the potential to earn the International Baccalaureate Diploma. For a student to be successful in this
program and be prepared for IB examinations, the student must be committed to a high quality education. Therefore, the
International Baccalaureate Diploma Program requires the student and the family to make the following commitment:
I (we) agree to the following terms and conditions for participation in IB:
1.
Follow the rules of Suffolk Public Schools as specified in the Student Handbook. A copy may be obtained from
the Suffolk Public Schools website or by contacting the main office at King’s Fork High School.
Meet the expectations of each class by participating in daily activities including completing homework, listening
attentively, offering relevant comments, posing insightful questions, and taking notes.
Work seriously to improve reading and writing skills.
Submit high quality work at deadlines.
Maintain a minimum GPA of 3.0 and abide by the Academic Review Process.
Exemplify the highest degree of academic and personal integrity. Cheating and repeated class disruptions are
grounds for dismissal from the program.
Exert concerted effort to schedule recreational trips and all appointments (such as medical and dental) outside of
the school day.
Remain in the program unless released by the recommendation of the IB Coordinator and the Academic Review
Committee. Motivation, attitude, and progress will determine continued involvement in the program.
2.
3.
4.
5.
6.
7.
8.
I understand that if I do not meet the standards of the IB Diploma program, either because of the quality of my work or
because of my performance as a serious learner, I may be asked to withdrawal from the program to enroll in a course of
study which better meets my level of performance. I also understand that if I leave the program, I may be requested to
return to my zone school and, according to Virginia High School League rules, I would not be eligible to participate in
VHSL activities for 365 days unless I am granted a waiver under rule 28-6-2 (14).
I am aware that by applying for the program, I will become a King’s Fork High School student eligible for extra-curricular
activities at the school and that I will earn my high school diploma from King’s Fork High School. I realize that if I
reside outside of the King’s Fork High School attendance zone, I will not be eligible to participate in
any extra-curricular activities at the home attendance zone high school while enrolled at King’s Fork
High School.
__________________________
Student Signature*
_____________________
Date
I understand that the selection committee will be looking at my child’s academic performance, confidential teacher
recommendations, the writing sample, and the interview process to determine my child’s eligibility for selection.
I grant permission for my son/daughter, if selected, to be enrolled in the International Baccalaureate Diploma
Program at King’s Fork High School. I will also support my child’s academic growth and encourage development of
independent study skills.
__________________________
Parent/Guardian Signature*
*Typing the name will serve as an electronic
signature and confirms agreement.
International Baccalaureate Program
11/16/15
_____________________
Date
2|Page
Suffolk Public Schools
International Baccalaureate Program
King’s Fork High School · 351 King's Fork Road ∙ Suffolk, VA 23434
Phone: (757) 923-5240 · Fax: (757) 923-5242
Amy Moncibais, IB Specialist (amymoncibais@spsk12.net)
Parent Recommendation Form
Student’s Name ___________________________
Middle School _________________________________
Directions to Parent: Your child is completing an application for the IB Program. Please mark the box below that best represents your assessment of
your child.
Note: Current teachers will also be asked to complete this form confidentially. You do not need to take action. The IB Coordinator will secure this
information.
Almost
Always
Often
Occasionally
Rarely
Never
Ease of Learning: Enjoys the challenge of problems, assignments,
and issues. Learns quickly.
Adaptability: Approaches ideas and problems from a number of
directions. Finds alternative means of solving problems. Thinks
about ideas in new ways.
Initiative and Enthusiasm: Is a highly motivated, independent
worker. Seeks additional tasks; is intellectually curious, and stays
actively engaged in activities.
Persistence: Stays with tasks; relates progress on tasks to
accomplishment of larger goals.
Reliability and Integrity: Is scrupulous and punctual in fulfilling
obligations; readily accepts responsibility.
Reasoning: Uses logical, analytical reasoning and/or creative
divergent thinking to consider ideas or solve problems. (Originality
and elaboration of thinking).
Communications: Communicates effectively.
Organization: Manages time, resources and materials; meets
deadlines; divides tasks into subtasks.
Leadership Qualities: Shows respect and tolerance of others’
views. Is willing to accept the ideas of others and contributes to the
group process. Influences others in a positive manner.
Success: Displays the ability to succeed in a challenging program.
Please provide any comments that might assist us in determining your child’s potential to succeed in a rigorous academic program.
Additional Comments:
Click here to enter text.
_________________________
Date
____________________________
Parent signature*
*Typing the name will serve as an electronic
signature and confirms agreement.
Thank you for completing this form. Your input is valued.
International Baccalaureate Program
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Suffolk Public Schools
International Baccalaureate Program
King’s Fork High School · 351 King's Fork Road ∙ Suffolk, VA 23434
Phone: (757) 923-5240 · Fax: (757) 923-5242
Amy Moncibais, IB Specialist (amymoncibais@spsk12.net)
Required Writing Samples
I.
Applicant’s Statement on Motivation
Directions: The IB Program is designed for students who are highly-motivated academically. Please
provide below in one paragraph an example of something that you do or have done, which demonstrates you
are an academically highly-motivated student. Include a brief explanation.
Click here to enter text.
II.
Applicant Formal Writing Sample Session
The Writing Sample will be administered the third week of January at each middle school.
Students will be allotted 1 ½ hour to complete the writing sample. Be sure to return your permission slip to
your guidance counselor.
INFORMATION

The student will be given a writing prompt and asked to write a composition of
more than one paragraph on the topic covered. The purpose of the writing
sample is to determine if the student possesses competent writing skills
necessary for success in the program.

The student should bring two pens. Paper will be provided.

If a student submits an application for the IB program but does not complete
the required writing sample, his or her application is considered to be
incomplete and cannot be evaluated by the IB Admissions Committee.

Please contact the IB Coordinator at amymoncibais@spsk12.net , if you have
any questions or concerns.
International Baccalaureate Program
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Suffolk Public Schools
International Baccalaureate Program
King’s Fork High School · 351 King's Fork Road ∙ Suffolk, VA 23434
Phone: (757) 923-5240 · Fax: (757) 923-5242
Amy Moncibais, IB Specialist (amymoncibais@spsk12.net)
International Baccalaureate
Formal Writing Session
Information and Permission Sheet
Directions: Parents, please complete this form, print it and return it to your child’s guidance counselor.
Student’s Name_________________________________________________________
Address________________________________________________________________
Phone_______________________________School_____________________________
Please Check:
My child has permission to participate in the International Baccalaureate Formal Writing
Session at my child’s middle school. I understand that the writing sample is a part of the
application process.
***Please Note: The participation of your child in the Writing Session for the International Baccalaureate
application process should not be interpreted as an implied, presumed or actual admission into the program.
_____________________________
Parent’s Signature*
International Baccalaureate Program
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Suffolk Public Schools
International Baccalaureate Program
King’s Fork High School · 351 King's Fork Road ∙ Suffolk, VA 23434
Phone: (757) 923-5240 · Fax: (757) 923-5242
Amy Moncibais, IB Specialist (amymoncibais@spsk12.net)
IB Honor Code
The IB Program offers a quality education that not only insures knowledge, but cultivates the virtues of honor,
courtesy, and perseverance. Of these virtues, honor is of great importance, for it is personal integrity that will
influence and finally determine many of our actions and beliefs. This Honor Code exists in order to uphold and
reinforce values that are central to the IB tradition of excellence and to prevent violations of that tradition such
as cheating or plagiarism. Students should consider this Honor Code to be enforced in all IB classes and all
activities associated with King’s Fork High School.
IB defines malpractice in the following way:
Malpractice:
behavior that results in, or may result in, the candidate or any other candidate gaining an
unfair advantage in any assessment component.
It may include:
1. Collusion: when a candidate knowingly allows his or her work to be submitted for
assessment by another candidate.
2. Plagiarism: the submission for assessment of the unacknowledged work, thoughts
or ideas of another person as the candidate's own.
3. Duplication of Work: the presentation of the same work for different assessment
component and/or diploma requirements.
4. Any other behavior which gains an unfair advantage for a candidate or which affects
the results of another candidate.
The King’s Fork IB Honor Code, simply stated, is:
Students shall be honor bound to refrain from cheating of every kind, including plagiarism. Students shall be
honor bound to take actions to stop any and all violations of this Honor Code which they see. Inaction implies
that one condones inappropriate behavior. Living in a manner that is consistent with this code will produce an
atmosphere of trust, freedom, and integrity necessary to the success of each student in this program. Without
maintaining a high standard of honesty and conduct, the reputation of the school and of IB are compromised
and society is poorly served.
Honor Pledge
I hereby pledge to uphold the Honor Code of the International Baccalaureate Program at King’s
Fork High School. I shall refrain from all forms of academic malpractice: cheating; plagiarism;
or other deceitful means of obtaining good grades.
If I have knowledge that a student has violated the honor code, I have an obligation to take action
to prevent damage to the program and its participants. I understand that breaches of the honor
code are punishable according to the King’s Fork handbook for student conduct and may result
in my removal from The International Baccalaureate Program and from King’s Fork High
School.
Student Signature* _________________
Date ___________________
Parent Signature *________________ Date__________________
*Typing the name will serve as an electronic signature and confirms agreement.
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