Morris Hills Regional District
Summer Acceleration 2015
Application Form
Student Name:
Date of Birth:
Address:
Primary Phone:
Secondary Phone:
Email address:
(please write legibly!)
Parent/Guardian Name:
Parent Email:
Student Grade Level in September 2015:
Most Recent School Attended:
The student wishes to enroll in (select one course only):
□ Algebra I
□ Geometry Honors
□ French I
Does the student have an IEP or 504 Plan?
Yes
□ German I
No
□ Spanish I
□ Personal Finance
If so, please attach a copy.
Dates for Algebra I, Geometry, and French, German, or Spanish I (8 AM to 1 PM, 5 credits each):
Class will meet on each date that is surrounded by a box in the calendars.
Dates for Personal Finance (8 AM to 1 PM, 2.5 credits)
Please select a preference if registering for this class:
□ Option 1:
□ Option 2:
Tuition
All courses except Personal Finance cost $450 for in-district and choice students attending Morris Hills or Morris Knolls
and $550 for out-of-district students if the application and payment is received by May 8th. Personal Finance costs $225
for in-district and choice students and $275 for out-of-district students. A $50 late fee will be charged if the application is
received after May 8th.
A reduced rate is available for in-district or choice students who meet the federal income eligibility criteria (please see
Tuition Calculator Worksheet).
Please make a check or money order out to Morris Hills Regional District and submit it with your application. There will
be a $50 fee for returned checks. All tuition is non-refundable unless a course is cancelled or if a student does not meet
prerequisites.
□ My child and I have read the course description, application, and FAQ. We certify with our signature below that we
understand the rules and regulations of the summer program and agree to follow them.
Student Signature:
Parent/Guardian Signature:
Date:
Applications, tuition, and all supporting documents must be returned by May 8th to: Morris Hills Regional District,
Summer Acceleration Program, 48 Knoll Drive, Rockaway, NJ 07866, Attn: Nisha Zoeller. Applications received after May
8th will be subject to a $50 late fee.
Current School Certification
This is a summer acceleration program for motivated students who can work independently and who turn work in on
time. Students will be completing 120 hours of coursework in a short period of time (60 hours for Personal Finance) and
will be earning 5 credits (2.5 credits for Personal Finance) towards their high school graduation requirements if they
successfully complete the course. Morris Hills and Morris Knolls High Schools will automatically accept coursework
completed through this program. We cannot guarantee that other high schools will accept this work—if you are an outof-district student, please talk to your guidance counselor before signing up!
For the Current School Guidance Counselor:
Please certify that the following pre-requisites have been met:
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This student is a motivated, independent worker who completes assignments on time and is capable of
successfully completing an accelerated course where extra help is not available outside of class:
Yes
No
Unsure
This is the first time the student is taking the course he/she has signed up for: Yes No
For Algebra I students only: This student is currently enrolled in or has completed Pre-Algebra: Yes No
This student was proficient on the NJASK 7
Yes No
For Geometry Honors students only: This student is currently enrolled in or has completed Algebra I: Yes No
My signature certifies that the student meets the above criteria as specified. A copy of the most recent report card and
NJASK scores (if applicable) are enclosed.
Guidance Counselor Name:
Date:
Phone Number:
Signature:
Email Address:
School:
Morris Hills Regional District
Summer Acceleration 2015
Tuition Calculator
Tuition: All courses except Personal Finance cost $450 for in-district and choice students attending Morris Hills or
Morris Knolls and $550 for out-of-district students. Personal Finance costs $225 for in-district students and $300 for
out-of-district students.
A reduced rate is available for in-district students who meet the federal income eligibility criteria.
2015 POVERTY GUIDELINES FOR THE 48
CONTIGUOUS STATES
AND THE DISTRICT OF COLUMBIA
Persons in family/household
Poverty guideline
For families/households with more than 8 persons, add
$4,060 for each additional person.
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1
$11,670
2
15,730
3
19,790
4
23,850
5
27,910
6
31,970
7
36,030
8
40,090
Any in-district or choice student whose family household income falls below the Federal Poverty Guideline as
listed above can attend tuition-free.
Any in-district or choice student whose family household income is above the Federal Poverty Guideline but
below the Guideline multiplied by 1.30 will pay 50% tuition.
Any in-district or choice student whose family household income is above the Federal Poverty Guideline
multiplied by 1.30 but below the Federal Poverty Guideline multiplied by 1.85 will pay 75% tuition.
If your family household income does not meet any of the above criteria, or if you are an out-of-district student,
you must pay full tuition in order to participate.
Any student who believes he/she qualifies for the reduced rate will be required to submit a family Income Tax
Return as evidence.
Reduction
50% tuition
75% tuition
All courses except Personal Finance
$225
$337.50
Personal Finance
$112.50
$168.75
□ I believe my child may qualify for a reduction in tuition. The number of people in my household is ____. My most
recent family Income Tax Returns are enclosed.
Morris Hills Regional District
Summer Acceleration 2015
Code of Conduct/Attendance Policy
The following rules will be strictly enforced. Students who violate any of these rules will be removed from the
program, and no refund will be given:
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No drugs or alcohol are permitted in the building or on school grounds.
Smoking is not permitted in the building or on school grounds.
Fighting, bullying, or harassment will result in immediate removal from the program.
Cell phones, iPods, and other electronic devices must be turned off before entering the building. Students may
not use electronic devices in the classroom without the permission of the teacher. Any student found to be
using an unauthorized electronic device will have it confiscated, and a parent/guardian must come to the school
to retrieve it.
Plagiarism, cheating, copying homework, or other forms of academic dishonesty will not be tolerated. Students
found with an unauthorized electronic device during an assessment will receive a zero on the assessment.
Offensive or disruptive items are not permitted.
Students must abide by the Summer Acceleration Attendance Policy. Students who miss a class will be
responsible for all missed work, including assessments. Teachers will not be available to re-teach a missed
lesson.
Students must abide by the District’s Acceptable Use Policy for all computers and electronic devices.
Students must abide by the dress code. All students should be dressed appropriately for an academic
environment. All shirts must have sleeves. All skirts or shorts must be no shorter than 5 inches above the knee.
Tight or revealing clothing is not permissible. Hats, bandanas, and hoods are not allowed.
Students will be held responsible for reimbursement for any damaged equipment or text that is not returned.
All transcripts will be held by the school until reimbursement is received.
Infractions not covered above will be handled at the discretion of the Administration in accordance with district
board policies.
Attendance Policy

Because of the accelerated nature of the summer program, daily attendance and punctuality are critical to
student success in the course. No more than 2 absences (regardless of the nature of the absence) will be
permitted for all courses except Personal Finance, which allows only 1 absence. If a student exceeds the
number of absences, he or she will automatically be withdrawn from the course, and no refund will be given. All
courses begin promptly at 8 AM and end at 1 PM. Students who arrive late (after 8 AM) or leave early (before 1
PM) on a regular basis will be removed from the course with no refund given.
I have read and agree to abide by the above Code of Conduct and Attendance Policy for the duration of the Summer
Acceleration Program. I understand that violation of the Code of Conduct could result in my withdrawal from the
Program, without refund. No student will be permitted to enroll in a course without signing and returning this form.
Student Name:
Student Signature:
Date:
Parent/Guardian Name:
Date:
Parent/Guardian Signature:
MORRIS HILLS REGIONAL DISTRICT
STUDENT:_
Last Name
SUMMER 2015
First Name
FATHER: _________________________________
(GUARDIAN) Name
Counselor
______________________
_______________________________
Signature
PLACE OF EMPLOYMENT:_______________________________________________
Grade
Home #
________________________
Work #
FATHER/GUARDIAN: _______________________________
Cell Phone #
MOTHER: _________________________________
(GUARDIAN) Name
_____________________________________________
E-Mail
_______________________________
Signature
PLACE OF EMPLOYMENT: _______________________________________________
______________________
Home #
________________________
Work #
MOTHER/GUARDIAN: _______________________________
Cell Phone #
_____________________________________________
E-Mail
EMERGENCY INFORMATION
In the event of illness or an emergency, and only if you are unable to pick-up your child, we will release your child only to an adult.
Upon verbal confirmation from you, and proper identification from the person listed below, we will then release the student.
Name of Adult:____________________________ Phone Number:___________________ Relationship to student:_____________
Name of Adult:____________________________ Phone Number:___________________ Relationship to student:_____________
□ If above persons are not available, you may call our family physician.
□ You have my permission to transport my child to a hospital in case of an emergency.
If your child walks to school, and you request the child to walk home (due to illness or emergency), please sign below indicating you
give permission for them to leave school grounds. Upon verbal confirmation from you and the school nurses’ medical sanction, we
will release the student from the attendance office. Please allow my child to sign-out with my permission.
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MEDICAL INFORMATION
STUDENT DATE OF BIRTH: _________________________
Month
Day
Year
Physician’s Name: _______________________________
Phone: __________________________ Last Visit: __________
Dentist’s Name: _______________________________
Phone: __________________________ Last Visit: __________
Eye Doctor’s Name: _______________________________
Phone: __________________________ Last Visit: __________
PLEASE CHECK ALLERGIES: Bees ______ Wasps ______ Yellow Jackets ______ Foods ______
Medication ______ Plants ______ Animals ______ Other ______
Treatment for allergies: ___________________________________________________________________________________
Is your child on any medication? Yes_____ No_____ Medication ___________________________________________
Dosage _________________ Time Given ________________ Doctor __________________________________
I give consent for the school nurse:
YES
NO
to share health information with appropriate school personnel for my child.
to contact my child’s physician regarding health information as needed.
Parent/Guardian Signature: __________________________________________ Date: ________________