Lake Wales High School Application & IB Registration Form 2016-2017
Henry McCance IB Program
#1 Highlander Way Lake Wales, FL 33853
Contact: Anuj Saran 863.215.8372 or anuj.saran@lwcharterschools.com
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Review the IB Website (www.ibo.org) carefully as this program is designed for students committed to academic achievement and
community service.
Please complete both pages of the application, attach photocopies of GPA (7th grade report card) and Test Scores, and submit two
recommendation forms.
Only complete applications will be considered for admission.
Enrollment criterion: GPA: 3.25 and above. Reading and Math FSA: Score at 55th/EOC with achievement level of 3 and above.
Deadline: December 1, 2015; rolling admissions based on space availability after December 1.
Student Information
Student ID# _________________________________ DOB (MM/DD/YYYY) _______/_______/_______ Gender (Please Circle): Male
Female
Applying for Grade (Please Circle): 9th 10th 11th 12th
Current School: _______________________________________________________________
Student Legal Name
Last Name: _____________________________________ First Name: _____________________________________ Middle Initial: ____________
Mailing Address
______________________________________________________________________________________________________ Apt # ____________
Street Address (Please Print)
____________________________________________________________________
City
__________
State
_____________________
Zip Code
Ethnic Code
This information will only be used to expand the programs benefits to all students
____ Asian/Pacific Islander
____ American Indian, Alaskan Native
____ Hispanic
____ Black
____ Multi-Racial, Non-Black
____ White, Non-Hispanic
Lake Wales Charter Schools does not discriminate in admission or access to, or treatment or employment in its programs and activities, on the basis of race, color,
religion, age, sex, national origin, marital status, disability, genetic information, sexual orientation, gender identity or expression, or any other reason prohibited by law.
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Office Use Only: Delivery Method: _____________________ Date Received: _____________________ Time: _____________________
Application Number: _____________________ Decision: _____________________
For Middle School Guidance Counselor Use:
____________________________________
Counselor Name
_______________________________
Office Number
__________________________________________
Email Address
ELA Percentile: ________________ Math Percentile: ________________ Middle School GPA: ________________
_____________________________________________
Counselor Signature
_____________________
Date
If you have taken any high school level classes, please enter EOC Score for all that apply and attach photocopy of score:
_______ Algebra 1
_______ Geometry
_______ Algebra II
_______ Spanish 1 (High School Level)
Other High School Course(s): ______________________________________________________________________________________
2016-2017 Electives
Agricultural Science Foundations
Personal Fitness
Early Childhood I
Culinary Operations I
JROTC
Psychology
Government/Economics
Creative Photography
Band I
Chorus I
Jazz Band I
Orchestra I
Dance I
Entrepreneurship
Coding
Digital Media & Multimedia Design
Basketball/Softball
Team Sports I/Team Sports II
Individual/Dual Sports
Personal Fitness
Physics
List your top four choices for electives for the 2016-2017 school year. Please understand that you may not receive your top choices.
My Chosen Electives
1st Choice:
2nd Choice:
3rd Choice:
4th Choice:
Family Information
Parent/Guardians (Living in same household as student applicant)
_______________________________________________
Parent Name
______________________________________________
Email Address
_______________________________________________
Home Phone Number
______________________________________________
Work or Cell Phone Number
Signature of Parent/Guardian: ______________________________________________________________ Date: ___________________
Mail or Deliver Completed and Signed Application with all photocopies to:
Lake Wales High School
Attention: Laura Sanchez
1 Highlander Way, Lake Wales, Florida 33853
Phone: 863.678.4222
http://lakewaleshigh.com/ib-program/
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