Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
Math Teacher Recommendation Request
To the Student: Please complete the information in the box and give this portion of the form to your math teacher.
Student’s Name ___________________________________________________________________
Last
First
Middle
Student’s Middle School ____________________________________________________________
To the Math Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early College
(CASEC). The CASEC is an Early College High School located on the campus of Statesville High School. Students attend
CASEC for five years and earn a high school diploma and an associate’s degree from Mitchell Community College. Thank you
for your assistance.
Please share your perceptions of how this student will meet the academic and social responsibilities of the school. Please
complete and submit the online Google doc form by February 4, 2016. Please go to www.iss.k12.nc.us/VPAC under “Quick
Links” and choose the correct form.
__________________________________________________
Math Teacher Signature (return request form to student)
__________
Date
(Cut along dotted line)
-------------------------------------------------------------------------------------------------------------------
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
Language Arts Teacher Recommendation Request
To the Student: Please complete the information in the box and give this portion of the form to your language arts teacher.
Student’s Name ___________________________________________________________________
Last
First
Middle
Student’s Middle School ____________________________________________________________
To the Language Arts Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early
College (CASEC). The CASEC is an Early College High School located on the campus of Statesville High School. Students
attend CASEC for five years and earn a high school diploma and an associate’s degree from Mitchell Community College.
Thank you for your assistance.
Please share your perceptions of how this student will meet the academic and social responsibilities of the school. Please
complete and submit the online Google doc form by February 4, 2016. Please go to www.iss.k12.nc.us/VPAC under “Quick
Links” and choose the correct form.
__________________________________________________
L.A. Teacher Signature (return request form to student)
__________
Date
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
Wheel or Fine Arts Teacher Recommendation Request
To the Student: Please complete the information in the box and give this portion of the form to your math teacher.
Student’s Name ___________________________________________________________________
Last
First
Middle
Student’s Middle School ____________________________________________________________
To the Math Teacher: The student named above is applying for admission to the Crossroads Arts and Science Early College
(CASEC). The CASEC is an Early College High School located on the campus of Statesville High School. Students attend
CASEC for five years and earn a high school diploma and an associate’s degree from Mitchell Community College. Thank you
for your assistance.
Please share your perceptions of how this student will meet the academic and social responsibilities of the school. Please
complete and submit the online Google doc form by February 4, 2016. Please go to www.iss.k12.nc.us/VPAC under “Quick
Links” and choose the correct form.
__________________________________________________
Wheel or Fine Arts Teacher Signature (return request form to student)
__________
Date
(Cut along dotted line)
-------------------------------------------------------------------------------------------------------------------
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
Counselor Recommendation Request
To the Student: Please complete the information in the box and give this portion of the form to your school counselor.
Student’s Name ___________________________________________________________________
Last
First
Middle
Student’s Middle School ____________________________________________________________
To the School Counselor: The student named above is applying for admission to the Crossroads Arts and Science Early College
(CASEC). The CASEC is an Early College High School located on the campus of Statesville High School. Students attend
CASEC for five years and earn a high school diploma and an associate’s degree from Mitchell Community College. Thank you
for your assistance.
Please share your perceptions of how this student will meet the academic and social responsibilities of the school. Please
complete and submit the online Google doc form by February 4, 2016. Please go to www.iss.k12.nc.us/VPAC under “Quick
Links” and choose the correct form.
________________________________________________
Counselor Signature (return request form to student)
__________
Date
Crossroads Arts and Science Early College
An Early College High School Partnership with Catawba College,
Mitchell Community College and Iredell-Statesville Schools
Data Manager Request
Section E. Records Release Form (Please give this form to data manager)
Student Name: _________________________________________________________________________
Power School ID: ______________________________________Date of Birth: _____________________
Consent to Access Records:
I hereby authorize counselors and/or institutions to release transcripts, educational records
(including but not limited to Individualized Education Plans (IEP), Section 504 Plans, Academically
and Intellectually Gifted (AIG) records, and ESL records), transcripts, attendance, discipline, testing
results, mid-term grade reports, and final grade reports regarding the above named student to the
Crossroads Arts and Science Early College. This authorization also allows Mitchell Community
College or other post-secondary institutions to release enrollment information, class schedules, midterm grade reports, and semester grade reports to the Crossroads Arts and Science Early College.
__________________________________________________________________________________________
Applicant Name (printed)
Applicant Signature
Date
__________________________________________________________________________________________
Parent/Guardian Name (printed)
Parent/Guardian Signature
Date
*Due to limited space, CROSSROADS reserves the right to interview applicants to help determine entry status. All students
and parents should be aware that an interview may be required before a student is accepted for enrollment.
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
To the data manager: 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. Return the attach release form to requested records in a sealed
envelope directly to CROSSROADS via mail at 476 N. Center St., Statesville, NC 28677 by February 4, 2016.