Personal Information:
Magruder HS
PEAC
Scholars
Application for the
2012-2013 School Year
Class of 2015
Name: __________________________________________ Student ID: _________
Last
First
MI
Email address: __________________________________________
Female
Male
Home address: _________________________________________________________
Number and Street
Apartment #
______________________________________________________________________
City or Town
State
Zip Code
Home phone: (_______)_______________ Cell phone: (_______)_______________
Summer Mailing Address (if different from above):
_____________________________________________________________________
Number and Street
Apartment #
_____________________________________________________________________
*Pursuing Excellence in the
Academic Curricula*
City or Town
State
Zip Code
Summer phone: (_______)________________
Current School: _________________________________ Counselor’s Name: _______________________________
(If coming from a school outside of MCPS, please attach a copy of your most recent transcript and note the name of your
counselor or advisor from that school.)
Current Math Class (course and level): _______________________________________
Desired PEAC Courses for 2012-2013 (select all that apply):
PEAC Honors English 10  PEAC AP US History 
PEAC Honors Biology 
Academic Honors:
Briefly list any academic honors you have received since the sixth grade.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Extracurricular Activities:
Please list the extracurricular activities and community service that you are currently involved in at middle school.
Grade-level
Time Commitment
Plan to continue?
Activity
of participation
7
8
9
Hrs
per wk
Wks
per yr
(Y or N)
For School Use Only:
Cumulative GPA: ___________ MSA Reading Grade 8: ____________________________ Math Grade 8: ________________________
scale score
MAP-R Percentile Rank: _____________
Teacher Recommendations: (1)___
Committee Decision:
(2)___
Yes 
scale score
proficiency level
Community Service Hours: ___________
(3)___
check if received
Essay Score: _____________
proficiency level
Counselor Recommendation: Y
N
circle one
Readers: ___________________ _____________________
No 
Student: please return this completed form, along with your essay (see p 6) and Form A to Magruder High School c/o Betty Nataro, Academy Director/RT
Page 1 of 6
Magruder
HS
PEAC
Scholars
Application for the
2012-2013 School
Year Class of 2015
Students, in order to be considered for the PEAC Scholars Program, please complete
the top portion of this recommendation form and distribute to three teachers who have
taught you in grade 9.
Student’s Name: _____________________________________ Student ID: _________
Last
First
MI
Teachers, please complete the following information for the student noted above who is
applying to the Magruder PEAC Scholars Program:
Teacher’s Name: __________________________________ Title: ________________
School Name: __________________________________________
Teacher’s email address: _________________________________________________
*Pursuing Excellence in
the Academic Curricula
Teacher’s phone number: (______)_______________________
The course(s) in which you have taught this student: ___________________________
Comparing this student to other students in his/her class, please evaluate this student on the following
characteristics.
Rating code: 5 points =Best, top 1%
4 points = Excellent
3 points = Good, above average
2 points = Average
1 point = Below Average
Quality
Points
Academic motivation
Attitude
Character, integrity
Creative, original thought
Discipline
Emotional maturity
Independence, initiative
Interpersonal skills
Work/Study habits
Positive response to academic challenge
Reliability, dependability
Analytical skills
TOTALS
What words would you use to describe this student? Please be specific and use words that would help to distinguish this
student.
_____________________________________________________________________________________________
Please provide the PEAC Scholar Selection Committee with any additional information regarding the academic
abilities, accomplishments, or character of this student:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Teacher’s Signature: ________________________________________________
Date: _____________________
Teacher/Counselors: Please return this completed form to the PEAC Application Coordinator at your school.
Please note that this form will remain confidential. Thank you for your time and invaluable feedback!
Page 2 of 6
Magruder
HS
PEAC
Scholars
Application for the
2012-2013 School
Year Class of 2015
Students, in order to be considered for the PEAC Scholars Program, please complete
the top portion of this recommendation form and distribute to three teachers who have
taught you in grade 9.
Student’s Name: _____________________________________ Student ID: _________
Last
First
MI
Teachers, please complete the following information for the student noted above who is
applying to the Magruder PEAC Scholars Program:
Teacher’s Name: __________________________________ Title: ________________
School Name: __________________________________________
Teacher’s email address: _________________________________________________
*Pursuing Excellence in
the Academic Curricula
Teacher’s phone number: (______)_______________________
The course(s) in which you have taught this student: ___________________________
Comparing this student to other students in his/her class, please evaluate this student on the following
characteristics.
Rating code: 5 points =Best, top 1%
4 points = Excellent
3 points = Good, above average
2 points = Average
1 point = Below Average
Quality
Points
Academic motivation
Attitude
Character, integrity
Creative, original thought
Discipline
Emotional maturity
Independence, initiative
Interpersonal skills
Work/Study habits
Positive response to academic challenge
Reliability, dependability
Analytical skills
TOTALS
What words would you use to describe this student? Please be specific and use words that would help to distinguish this
student.
_____________________________________________________________________________________________
Please provide the PEAC Scholar Selection Committee with any additional information regarding the academic
abilities, accomplishments, or character of this student:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Teacher’s Signature: ________________________________________________
Date: _____________________
Teacher/Counselors: Please return this completed form to the PEAC Application Coordinator at your school.
Please note that this form will remain confidential. Thank you for your time and invaluable feedback!
Page 3 of 6
Magruder
HS
PEAC
Scholars
Application for the
2012-2013 School
Year Class of 2015
Students, in order to be considered for the PEAC Scholars Program, please complete
the top portion of this recommendation form and distribute to three teachers who have
taught you in grade 9.
Student’s Name: _____________________________________ Student ID: _________
Last
First
MI
Teachers, please complete the following information for the student noted above who is
applying to the Magruder PEAC Scholars Program:
Teacher’s Name: __________________________________ Title: ________________
School Name: __________________________________________
Teacher’s email address: _________________________________________________
*Pursuing Excellence in
the Academic Curricula
Teacher’s phone number: (______)_______________________
The course(s) in which you have taught this student: ___________________________
Comparing this student to other students in his/her class, please evaluate this student on the following
characteristics.
Rating code: 5 points =Best, top 1%
4 points = Excellent
3 points = Good, above average
2 points = Average
1 point = Below Average
Quality
Points
Academic motivation
Attitude
Character, integrity
Creative, original thought
Discipline
Emotional maturity
Independence, initiative
Interpersonal skills
Work/Study habits
Positive response to academic challenge
Reliability, dependability
Analytical skills
TOTALS
What words would you use to describe this student? Please be specific and use words that would help to distinguish this
student.
_____________________________________________________________________________________________
Please provide the PEAC Scholar Selection Committee with any additional information regarding the academic
abilities, accomplishments, or character of this student:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Teacher’s Signature: ________________________________________________
Date: _____________________
Teacher/Counselors: Please return this completed form to the PEAC Application Coordinator at your school.
Please note that this form will remain confidential. Thank you for your time and invaluable feedback!
Page 4 of 6
Magruder HS
PEAC
Scholars
Application for the
2012-2013 School Year
Class of 2015
Students, in order to be considered for the PEAC Scholars Program, please
complete the top portion of this recommendation form and distribute to your
counselor for the 2011-2012 school year.
Student’s Name: _____________________________________ Student ID: _________
Last
First
MI
Counselor, please complete the following information for the student noted above
who is applying to the Magruder PEAC (Pursuing Excellence in the Academic
Curricula) Scholars Program:
Counselor’s Name: __________________________________
School Name: __________________________________________
Counselor’s email address: ________________________________________________
*Pursuing Excellence in the
Academic Curricula
Counselor’s phone number: (______)_______________________
Student GPA/Grade Average (unweighted): _________
MAP-R Percentile Rank: _____________
Community Service Hours: ___________
HSA Scores (if taken)
Algebra ____________
English ____________
Biology ___________
Directions: Comparing this student to other students in his/her grade level, please evaluate this student on the
following characteristics.
Rating code: 5 points =Best, top 1%
4 points = Excellent
3 points = Good, above average
2 points = Average
1 point = Below Average
Quality
Points
Academic motivation
Attitude
Character, integrity
Creative, original thought
Discipline
Emotional maturity
Independence, initiative
Interpersonal skills
Work/Study habits
Positive response to academic challenge
Reliability, dependability
Analytical skills
TOTALS
Please provide the PEAC Scholar Selection Committee with any additional information regarding the academic
abilities, accomplishments, or character of this student:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________________
Counselor’s Signature: ______________________________________________ Date: _____________________
Teacher/Counselors: Please return this completed form to the PEAC Application Coordinator at your school.
Please note that this form will remain confidential. Thank you for your time and invaluable feedback
Page 5 of 6
Magruder High School
PEAC Scholars
*Pursuing Excellence in the Academic Curricula*
Application Essay for 2012-2013 School Year
Students, please respond to ONE of the following three essay prompts in a well-developed,
multiparagraph essay; both content and writing must be your own. The essay must be
typed, double-spaced, in 12 point Times New Roman font with standard margins on white
paper. Please make sure to put your name, current school, and student ID number at the
top of the first page.
Essay Prompt 1) Discuss the major stressors in teens' lives.
Essay Prompt 2) Describe two things you would like to change about the world and explain why you
would change them.
Essay Prompt 3) Select three objects that symbolize our culture and explain why you selected them.
Applicant: Please return the completed essay, along with Page 1, the Student Application, and Form A, the Student “Receipt” to Betty
Nataro, Academy Director/RT, Magruder High School.
Page 6 of 6