Dublin City School District
Application for the Dublin City Schools
Engineering Academy
Program
2370 F2
Revised 2/1/12
Page 1 of 5
Print form single-sided
Student name: _______________________________________________________________________
Information Page / Checklist
____ Completed Application Form (pages 1 & 2)
____ Completed Teacher Recommendation Forms (pages 3 & 4)
Requirements: Please distribute these forms to two teachers whom you know well. Make sure
they are aware this is a confidential recommendation and that he/she needs to return the form to
your school counselor by Monday, April 16, 2012 by 2:30 pm.
Teacher name: __________________________________________________
Teacher name: __________________________________________________
____ Completed Essay
Requirements: 1-2 pages typed, double spaced in 12 font, one inch margins, with your name,
home school, and date in the upper right corner of the essay.
Topic: Why I Want to Study Engineering
Criteria: Within the context of your essay, please address the following as they relate to
the engineering field.
• Explore engineering as a profession and your compatibility for a career in
engineering.
• Explain why participation in the Engineering Academy is important for you.
• Other items that address your interest in studying engineering.
____ Completed Counselor Form (page 5)
Requirements: Please distribute this form to your high school counselor and ask him/her to
complete by Monday, April 16, 2012 by 2:30 pm.
Counselor name: _________________________________________________
____ Copy of your valid Ohio driver’s license or anticipated date: ____________________________
All six items must be returned to your school counselor by Monday, April 16, 2012 by 2:30 pm.
Program
2370 F2
Revised 2/1/12
Page 2 of 5
Application for the Dublin City Schools Engineering Academy
Print form single-sided
Deadline for application is Monday, April 16, 2012 by 2:30 pm.
Student name: _____________________________________________
High school:
Coffman ____
Jerome ____
Female: ____
Male: ____
Scioto ____
Home address: ______________________________________________________________________
Cell phone: ___________________________
Home phone: ___________________________
Email: _____________________________________________________________________________
Admission Requirements for Dublin Engineering Academy
Junior or Senior Status
25 ACT Composite Score
Top 15% of Class
(2) Teacher Recommendation Forms
Essay
Pre-Calculus Completion
Counselor Form
Good Attendance
Valid Ohio Driver’s License
Proof of Car Insurance
Reliable Transportation
OSU Academy Application
Parent/Guardian Information
Name(s): ___________________________________________________________________________
Relationship(s): _____________________________________________________________________
Work phone and/or Home phone: _______________________________________________________
Cell phone(s): _______________________________________________________________________
Email: _____________________________________________________________________________
Home address: ______________________________________________________________________
Student signature: ______________________________________
Date: ____________________
Parent signature: _______________________________________
Date: ____________________
Program
2370 F2
Revised 2/1/12
Page 3 of 5
Application for the Dublin City Schools Engineering Academy
Teacher Recommendation Form
Print form single-sided
My parent/guardian and I waive the right to review this recommendation.
Student signature: ___________________________________________
Date: _______________
Parent signature: ____________________________________________
Date: _______________
Confidential (for use by the selection committee for the Dublin Engineering Academy): This document will be
used to help select the best candidates for the Dublin Engineering Academy. Each student has been asked to
select two teachers in the Dublin City Schools to complete this evaluation for candidacy. Please feel free to write
any additional information on the back of this form that you feel would be beneficial.
Please return to the guidance office by Monday, April 16, 2012 by 2:30 pm.
Student name: _______________________________________________________________________
Recommending Teacher: ______________________________________________________________
How do you know this student: _________________________________________________________
___________________________________________________________________________________
Please check all that apply. The following list of characteristics / attributes employers value most is
adapted from the Job Outlook by the National Association of Colleges and Employers.
No Basis
for
Judgment
Communication Skills
Teamwork Skills
Interpersonal Skills
Strong Work Ethic
Motivation / Initiative
Flexibility / Adaptability
Analytic Skills
Organizational Skills
Leadership Skills
Creativity
Below
Average
Average
Above
Average
Excellent,
Top 5-10%
One of the
top few
encountered
in my career
Program
2370 F2
Revised 2/1/12
Page 4 of 5
Application for the Dublin City Schools Engineering Academy
Teacher Recommendation Form
Print form single-sided
My parent/guardian and I waive the right to review this recommendation.
Student signature: ___________________________________________
Date: _______________
Parent signature: ____________________________________________
Date: _______________
Confidential (for use by the selection committee for the Dublin Engineering Academy): This document will be
used to help select the best candidates for the Dublin Engineering Academy. Each student has been asked to
select two teachers in the Dublin City Schools to complete this evaluation for candidacy. Please feel free to write
any additional information on the back of this form that you feel would be beneficial.
Please return to the guidance office by Monday, April 16, 2012 by 2:30 pm.
Student name: _______________________________________________________________________
Recommending Teacher: ______________________________________________________________
How do you know this student: _________________________________________________________
___________________________________________________________________________________
Please check all that apply. The following list of characteristics / attributes employers value most is
adapted from the Job Outlook by the National Association of Colleges and Employers.
No Basis
for
Judgment
Communication Skills
Teamwork Skills
Interpersonal Skills
Strong Work Ethic
Motivation / Initiative
Flexibility / Adaptability
Analytic Skills
Organizational Skills
Leadership Skills
Creativity
Below
Average
Average
Above
Average
Excellent,
Top 5-10%
One of the
top few
encountered
in my career
Program
2370 F2
Revised 2/1/12
Page 5 of 5
Application for the Dublin City Schools Engineering Academy
Print form single-sided
School Counselor Form
Student name: _______________________________________________
Attending high school:
Coffman ____
Jerome ____
Date: ________________
Scioto ____
Testing Information
•
Has this student passed all parts of the OGT?
•
ACT Composite Score: _________
Yes ____
No ____
Credit Information
•
Has this student completed or scheduled at least 2 years of the same foreign language by the
end of his/her senior year?
Yes ____
No ____
•
Has this student completed at least one visual or performing art credit?
Yes ____
No ____
•
Has this student completed or is he/she enrolled in advanced rigorous course work? (AP, IB)
Yes ____
No ____
•
List high school math courses the student will have completed by the end of his/her
sophomore year?
__________________________________________________________________________
•
Courses needed during his/her senior year for graduation:
__________________________________________________________________________
__________________________________________________________________________
Other Information
Attendance (number of days absent):
Grade 9 _____
Grade 10 _____
Grade 11 _____
Cumulative GPA: _________
Class rank _____ / _____ through 5th semester
Received OSU Academy Application
Yes ____
No ____
Counselor signature: __________________________________________
Date: _______________