Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
476 North Center Street - Statesville, NC 28677 - Phone: (704) 978-0034 - Fax: (704) 978-0035
* * * * * * * * * * * * * * * * * * * * * * * * MATH TEACHER RECOMMENDATION * * * * * * * * * * * * * * * * * * * *
To the Student: Please fill in your information in the box below and give this form to a CURRENT academic teacher.
Student Name:______________________________________________ (last, first, middle)
Student’s current middle school: ____________________________________________
To the Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS). CROSSROADS
is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and earn a high school
diploma and an Associate’s Degree or two years of college credit. Please use this form to share your perceptions of how this student will meet the
academic and social responsibilities of the school. Return the completed recommendation form in a sealed envelope directly to CROSSROADS via
mail at 476 N. Center St., Statesville, NC 28677 by February 4, 2016.
Teacher Name: _____________________________________
Email address: ___________________________________
How long have you known the applicant? _____________
Current subject grade: _____________________
Poor
1
2
3
4
5
Superior
6
N/A or Not
Observed
Academic Ability in Subject
Daily Preparation
Participation
Motivation (Very Important)
Verbal Communication Skills
Problem-Solving
Ability to Work as a Team
Member
Leadership Skills
Assignments submitted on time &
complete
1. Do you recommend this student to the CROSSROADS program (ALL Honors and College level)? Please
explain: ___________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. Please describe this student’s attitude/work ethic (include any behavioral issues). ______________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
3. Please describe this student’s at-risk factors (for example: dropping out, peers ostracize, misfit-ness,
IEP/ESL/504, underachiever, requires strong school/teacher support, recent adoption/group home, socioeconomic status, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4. What is the next recommended level of math for this student? __Foundations of Math I __Math I __ Math II
Teacher Signature _____________________________________________________
Date
_______________________
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
476 North Center Street - Statesville, NC 28677 - Phone: (704) 978-0034 - Fax: (704) 978-0035
* * * * * * * * * * * * * * * * * * * * * * * * LANGUAGE ARTS TEACHER RECOMMENDATION * * * * * * * * * * * * * * * *
To the Student: Please fill in your information in the box below and give this form to a CURRENT academic teacher.
Student Name:______________________________________________ (last, first, middle)
Student’s current middle school: ____________________________________________
To the Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS). CROSSROADS
is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and earn a high school
diploma and an Associate’s Degree or two years of college credit. Please use this form to share your perceptions of how this student will meet the
academic and social responsibilities of the school. Return the completed recommendation form in a sealed envelope directly to CROSSROADS via
mail at 476 N. Center St., Statesville, NC 28677 by February 4, 2016.
Teacher Name: _____________________________________
Email address: ____________________________________
How long have you known the applicant? ______________________ Current subject grade: ____________________
Poor
1
2
3
4
5
Superior
6
N/A or Not
Observed
Academic Ability in Subject
Daily Preparation
Participation
Motivation (Very Important)
Verbal Communication Skills
Problem-Solving
Ability to Work as a Team
Member
Leadership Skills
Assignments submitted on time &
complete
Do you recommend this student to the CROSSROADS program (ALL Honors and College level)? Please
explain: __________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. Please describe this student’s attitude/work ethic (include any behavioral issues). ______________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
3. Please describe this student’s at-risk factors (for example: dropping out, peers ostracize, misfit-ness,
IEP/ESL/504, underachiever, requires strong school/teacher support, recent adoption/group home, socioeconomic status, etc.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Teacher Signature _____________________________________________________
Date
_______________________
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
476 North Center Street - Statesville, NC 28677 - Phone: (704) 978-0034 - Fax: (704) 978-0035
* * * * * * * * * * * * * * * * WHEEL OR FINE ARTS TEACHER RECOMMENDATION * * * * * * * * * * * * * * *
To the Student: Please fill in your information in the box below and give this form to a CURRENT fine arts teacher.
Student Name:______________________________________________ (last, first, middle)
Student’s current middle school: ____________________________________________
To the Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS). CROSSROADS
is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and earn a high school
diploma and an Associate’s Degree or two years of college credit. Please use this form to share your perceptions of how this student will meet the
academic and social responsibilities of the school. Return the completed recommendation form in a sealed envelope directly to CROSSROADS via
mail at 476 N. Center St., Statesville, NC 28677 by February 4, 2016.
Teacher Name: _____________________________________
How long have you known the applicant?
Poor
1
Email address: ____________________________________
________________________________________________________________
2
3
4
5
Superior
6
N/A or Not
Observed
Academic Ability in Subject
Daily Preparation
Participation
Motivation (Very Important)
Verbal Communication Skills
Problem-Solving
Ability to Work as a Team
Member
Leadership Skills
Assignments submitted on time &
complete
1. Do you recommend this student to the CROSSROADS program (ALL Honors and College level)? Please explain:
__________________________________________________________________________________________________
__________________________________________________________________________________
2. Please describe this student’s attitude/work ethic (include any behavioral issues). Please explain
__________________________________________________________________________________________________
__________________________________________________________________________________
3. Please describe this student’s at-risk factors (for example: dropping out, peers ostracize, misfit-ness, IEP/ESL/504,
underachiever, requires strong school/teacher support, recent adoption/group home, socio-economic status, etc.)
__________________________________________________________________________________________________
__________________________________________________________________________________
4. Fine Arts teachers only, please rank this student’s artistic skill level 1-5 (1-low, 5-high):
Rank #___________ Skill Area____________________________________________________
(We use this for class placement; students are NOT required to have high artistic skill levels to attend CROSSROADS)
Teacher Signature _____________________________________________________
Date
_______________________
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
476 North Center Street - Statesville, NC 28677 - Phone: (704) 978-0034 - Fax: (704) 978-0035
* * * * * * * * * * * * * * * * * * * ** COUNSELOR/ADMINISTRATOR RECOMMENDATION * * * * * * * * * * * * * * * * *
To the Student: Please fill in your information in the box below and give this form to your CURRENT counselor.
Student Name:________________________________________________________________________
(last, first, middle)
Student’s current middle school: _________________________________________________________
To the counselor: The student named above is applying for admission to the Crossroads Arts and Science Early College (CROSSROADS).
CROSSROADS is an Early College High School located on the campus of Statesville High School. Students attend CROSSROADS for five years and
earn a high school diploma and an Associate’s Degree or two years of college credit. Please use this form to share your perceptions of how this student
will meet the academic and social responsibilities of the school. Return the completed recommendation form in a sealed envelope directly to
CROSSROADS via mail at 476 N. Center St., Statesville, NC 28677 by February 4, 2016.
Counselor Name:______________________________ Email Address: _______________________________
1. How long have you known the student? ____________
2. Describe any at-risk factors for this student. (Examples include, but are not limited to: lack of family
support, IEP/ESL/504, needs extensive teacher support, recently adopted or placed in group home, severely
ostracized by peers, likely to drop-out, misfit-ness, socio-economic status, etc.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. All classes at CROSSROADS are at the Honors level, and college level. Explain their potential success in
rigorous
Classes and preparedness for Honors and College courses: _______________________________________
______________________________________________________________________________________
______________________________________________________________________________________
4. Describe the student’s attitude, work ethic, motivation, and include any behavioral concerns.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
5. CROSSROADS students have more flexibility and freedom in their school day than traditional schools.
Based on your experience with this student, do you believe they have the maturity to manage this freedom?
Will they attend college classes as required, not abusing the freedom they are given? If no, please explain.
Does this student receive services in any of the following programs? Check all that apply.
______ IEP
______ 504 Plan
______ ESL _______ AIG/math ______ AIG/Reading ____ No services
Counselor Signature ___________________________________________________
Date
_______________________
Application for Admission – 2015/2016 School Year
CHECKLIST
For student’s use only
Check off as you have completed and have each of the following ready to turn in:
__________
Application Part A: Demographic Information (completed by the parent/guardian)
__________
Application Part B: Student Section
__________
Application Part C: Statement of Commitment
__________
Records Release Form: (both student and parent/guardian must read and sign)
__________
All three Teacher Recommendation Forms should be returned to you in a sealed envelope or sent directly
to us from the teacher. The Counselor Recommendation Form will be sent directly to CROSSROADS
from the counselor. Please make sure that your recommendation forms have been sent. CROSSROADS
staff is not responsible for tracking them down.
You must request the following documents have them submitted by your school counselor or data manager .
_____ Historical Grade Report
_____ Daily Attendance Report Summary
_____ Explore Scores
_____ Test results
_____ Discipline Report ___ Enclosed ___ NA (no report needed)
_____ IEP/504/ESL plan ___ Enclosed ___ NA
Please return this completed application (with all paperwork, records, and recommendations) in
person or postmarked no later than February 4th, 2016 to the following address:
Crossroads Arts and Science Early College
476 North Center Street – Statesville, NC 28677
Phone: (704) 978-0034
Fax: (704) 978-0035