Solicitud de Admisión
Programa MI CASA
601 South College Rd.
Wilmington, NC 28403
Phone: (910) 962-2631 Fax: (910) 962-2543
PARTE A: Para ser completada por el SOLICITANTE
(..) Solicitud
(..) Contrato del Estudiante
(..) Crear una cuenta en Sealevel
(..) Respuesta Corta
(..) Ensayo del Estudiante
PARTE B: Para ser completada por el PADRE/MADRE/TUTOR
(..) Información del padre/madre/tutor
(..) Demografía del padre/madre/tutor
(..) Respuesta corta del padre/madre/tutor
PARTE C: Formularios de referencias para ser completados por el MAESTRO TITULAR
(..) Maestro de Inglés
(..) Maestro de Matemáticas
(..) Maestro a elección
PARTE D: Formulario de Registro
PADRE/MADRE/TUTOR y el CONSEJERO
de
Notas
para
ser
completado
por
el
(..) Formulario de Pedido de Acceso a los Registros de Notas
(..) Transcripción actual
(..) Perfil de Asistencia
(..) Perfil de Disciplina
Nombre del Estudiante: _____________________________Escuela: _____________________________________
1
PART A: To be completed by APPLICANT.
STUDENT INFORMATION
Nomination Criteria
 Must be a rising 11th grade Hispanic Student.
 Must have demonstrated on-going commitment to attending a post-secondary
school.
 Must have satisfactory academic transcripts, discipline records and course
selections.
 Must be U.S. citizen or Legal Permanent Resident.
Applicant Information
Student Name _______________________________________________________________________________________
(Last)
(First)
(Middle)
School Name: _________________________________________________________________________________________
Date of Birth: _________________________________________________________________________________________
Student e-mail:___________________________
Student Cell # _______________________________________
Parents place of birth: ___________________________ Student’s Nationality _______________________
Create SeaLevel Account
www.uncw.edu/admissions/sealevel.htlm
SeaLevel Username: ___________________________
Status
( ) U.S. Citizen
( ) U.S. Resident
( ) DACA
( ) Undocumented
Additional Information
Hobbies (sports, art, music, travelling, etc.)
_________________________________
____________________________________
_________________________________
____________________________________
_________________________________
____________________________________
List all your recent accomplishment/awards (academics, community or athletics)
______________________________
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________________________
______________________________
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Please tell us about any extracurricular activities (community, church, Sports)
______________________________
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2
Contrato del Estudiante del Programa de UNCW MI CASA
El Programa de Iniciativa para Mentores para la Acción, Apoyo y Defensa de la Comunidad
(MI CASA, por sus siglas en inglés) está diseñado para ampliar las oportunidades educativas
de los estudiantes hispanos/latinos de las escuelas secundarias de los condados de Pender,
Brunswick y New Hanover. MI CASA es un programa de apoyo abarcador que proporciona
servicios de mentoría, tutoría, proyectos de servicio comunitario, preparación para la
universidad y oportunidades de enriquecimiento cultural. Se utilizan dichos servicios para
ayudar a los estudiantes a convertirse en candidatos atrayentes con el fin de que sean
admitidos en la universidad.
Como alumno esperamos que:




asistas a todos los eventos de MI CASA (los problemas de transporte no justifican la
falta a los eventos. Si tienes problemas de transporte, comunícate con el Coordinador
del Programa o con tu mentor de UNCW con 24 horas de anticipación);
te comuniques con tu mentor todas las semanas vía correo electrónico, teléfono o
redes sociales);
trabajes con tu mentor y completes todas las tareas. Pídele ayuda a tu mentor o al
Coordinador del Programa;
planees el calendario de clases teniendo en cuenta las sugerencias de tu mentor de
UNCW y del Coordinador del Programa.
Además de lo arriba citado, en tu último año de la secundaria también deberás:


investigar y solicitar cinco becas.
Solicitar admisión en por lo menos 3 colegios universitarios y universidades.
Es requisito excluyente solicitar admisión a UNC Wilmington.
MI CASA no puede garantizarle la admisión a UNCW ni los fondos para estudiar en la
universidad a ningún estudiante. Proporcionaremos todos los recursos posibles para
asegurar que cada estudiante que complete nuestro programa pueda alcanzar la educación
universitaria.
Firma del Solicitante ____________________________________
3
Fecha _________________________
Short Answer
1.
What are your career goals?
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2.
How do you think MI CASA will help you?
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3.
What is your greatest strength?
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4.
How would your teachers describe you as a student?
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5.
Have you had behavior or disciplinary problems at school or have you ever
been suspended? If yes, explain.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
4
Student Essay
Please write an essay describing your reasons for going to college and why you should be
selected to this program. Include ways in which you will contribute to the UNCW Seahawk
Family during your two years with us.
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5
PARTE B: para ser completada por el PADRE/MADRE/TUTOR
Información del Padre/Madre/Tutor
Nombre del padre/madre/tutor _________________________________________________________________
(Apellido)
(Nombre)
(Nombre Segundo)
Dirección: __________________________________________________________________________________________
(Número de calle)
(Calle)
_______________________________________________________________________________________________________
(Ciudad)
(Condado)
(Estado)
(Código Postal)
Números de teléfono
Madre
__________________
(Casa)
Padre
__________________
(Casa)
Tutor_________________
______________
(Casa)
_____________________
(Celular)
_____________________
(Celular)
_____________________
(Celular)
Correo electrónico del padre/madre/tutor
_______________________________
(Trabajo)
_______________________________
(Trabajo)
_______________________________
(Trabajo)
_______________________________________________________
Educación
Completar según
corresponda
No se graduó
de la escuela
secundaria
Examen de
Desarrollo de
Educación
General (GED) o
Escuela
Secundaria
Equivalencia
Escuela
Secundaria
Número
de años de
estudio
en la Universidad
Título
obtenido
PADRE/MADRE/TUTOR
PADRE/MADRE/TUTOR
Cantidad de personas que viven en la casa
Por favor marque según corresponda
2
3-4
5-6
Por favor marque el ingreso familiar que corresponda
menor de
menor de
menor de
menor de
Ingreso familiar
$25.000
$35.000
$45.000
$55.000
anual estimado
7-8
menor de
$65.000
9+
más de
+75.000
Evalúe las siguientes características de su niño(a)
Características
Raramente
1
- +
2
Ocasionalmente
3
-+
4
Mayormente
5
Motivado para alcanzar el éxito en la escuela
Acepta responsabilidades para aprender
Trabaja bien con pares y hermanos(as)
Acepta la responsabilidad de sus propias acciones
Toma decisiones responsables y juiciosas
Respeta a los demás
Tiene problemas con la autoridad
Por favor lea con detenimiento
Al entregar esta solicitud entiende y concuerda que:
Cualquier problema de asistencia o comportamiento será causa suficiente para rescindir la admisión al
programa MI CASA.
Firma del Padre/Madre/Tutor ___________________________
6
Fecha ________________________________
¿Por qué desea que su niño(a) participe en el Programa de Mentoría de MI CASA?
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¿En qué forma le brindará apoyo a su niño(a) como participante del programa MI CASA?
_______________________________________________________________________________________________________
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PARTE C: UNCW MI CASA Mentoring Program.
Reference Form to be completed by current of former ENGLIGH TEACHER. Please email this form to
monteroc@uncw.edu by May 1st. Email Subject: MI CASA RECOMMENDATION
The MI CASA (Mentors Initiating Community Action, Support, and Advocacy) mentoring program at the
University of North Carolina Wilmington is designed to provide access to higher education to Hispanic/Latino
high school students in North Carolina.
Student Name:______________________________________________________________________________________
Least
→ →
to
→ →
Highest
Education
Academic potential
Academic preparation
Academic ambition/aspirations
Academically responsible and reliable
Study skills/ habits
Quality of academic work
Maturity for the college environment
Mature behavior
Responsible behavior
Confidence
Peer relations
Respect for other’s study needs
Respect for campus grounds and rules
Initiative to work independently
Class attendance, promptness to class
Achievement attitude
Academically responsible/reliable
Works without
accommodations/assistance
Prompt completion of assignments
Teacher relations
Based on my experience with the applicant, I make the following recommendation:
( ) Highly Recommend
( ) Recommend
( ) Recommend with reservation
Name :______________________________________________
(please print)
Signature:___________________________________________
( ) Not Recommend
Position:_____________________________
(please print)
Date:_________________________________
Comments:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
8
PARTE C: UNCW MI CASA Mentoring Program.
Reference Form to be completed by current or former MATH TEACHER. Please email this form to
monteroc@uncw.edu by May 1st. Email Subject: MI CASA RECOMMENDATION
The MI CASA (Mentors Initiating Community Action, Support, and Advocacy) mentoring program at the
University of North Carolina Wilmington is designed to provide access to higher education to Hispanic/Latino
high school students in North Carolina.
Student Name ______________________________________________________________________________________
Least
→ →
to
→ →
Highest
Education
Academic potential
Academic preparation
Academic ambition/aspirations
Academically responsible and reliable
Study skills/ habits
Quality of academic work
Maturity for the college environment
Mature behavior
Responsible behavior
Confidence
Peer relations
Respect for other’s study needs
Respect for campus grounds and rules
Initiative to work independently
Class attendance, promptness to class
Achievement attitude
Academically responsible/reliable
Works without
accommodations/assistance
Prompt completion of assignments
Teacher relations
Based on my experience with the applicant, I make the following recommendation:
( ) Highly Recommend
( ) Recommend
( ) Recommend with reservation
Name ________________________________________________
(please print)
Signature:__________________________________________________
( ) Not Recommend
Position:_____________________________
(please print)
Date:_________________________________
Comments:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
9
PARTE C: UNCW MI CASA Mentoring Program.
Reference Form to be completed by student’s TEACHER OF CHOICE. Please email this form
to monteroc@uncw.edu by May 1st. Email Subject: MI CASA RECOMMENDATION.
The MI CASA (Mentors Initiating Community Action, Support, and Advocacy) mentoring program at
the University of North Carolina Wilmington is designed to provide access to higher education to
Hispanic/Latino high school students in North Carolina.
Student Name ______________________________________________________________________________________
Least
→ →
to
→ →
Highest
Education
Academic potential
Academic preparation
Academic ambition/aspirations
Academically responsible and reliable
Study skills/ habits
Quality of academic work
Maturity for the college environment
Mature behavior
Responsible behavior
Confidence
Peer relations
Respect for other’s study needs
Respect for campus grounds and rules
Initiative to work independently
Class attendance, promptness to class
Achievement attitude
Academically responsible/reliable
Works without
accommodations/assistance
Prompt completion of assignments
Teacher relations
Based on my experience with the applicant, I make the following recommendation:
( ) Highly Recommend
Name
( ) Recommend
( ) Recommend with reservation
(please print)
Signature______________________________________________
( ) Not Recommend
Position_____________________________
(please print)
Date__________________________________
Comments:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
10
PARTE D: Formulario de Pedido de Acceso a los Registros de Notas y Recomendación del
Consejero.
PARA SER COMPLETADA POR EL PADRE/MADRE/TUTOR: Es esencial tener acceso a los
registros de notas para el programa de mentoría pre-universitaria y el proceso de
planeamiento. (Educational Records Access Request Form The UNCW MI CASA Mentoring Program strives to
provide valuable assistance to students in regard to gaining college access. Review of school records is essential
in the pre-college mentoring and planning process.)
Por la presente autorizo al Coordinador del Programa de UNCW MI CASA a acceder a todos
los registros académicos de mi niño(a). (I hereby grant full access to my child’s academic records to
UNCW MI CASA Program Coordinator.)
Nombre del Estudiante (Student Name): _____________________________________________________________
Nombre del Padre/Madre/Tutor: __________________________________________________________________
Padre Firma: _________________________________________________________________________________________
TO BE COMPLETED BY COUNSELOR
Grades
Please email a copy of the applicant’s most recent transcript to monteroc@uncw.edu
Attendance
Total Absences for the current year______________________________________________________________
Disciplinary Actions
Has the applicant had school disciplinary infractions during 9th or 10th grade? ( ) YES ( ) NO
If yes, please comment on the frequency and reasons.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Based on my experience with the applicant, I make the following recommendation:
( ) Highly Recommend
Name
( ) Recommend
( ) Recommend with reservation
(please print)
Signature______________________________________________
( ) Not Recommend
Position_____________________________
(please print)
Date__________________________________
Comments:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
11