801 Discovery Boulevard ~ Shelbyville, KY 40065 ~ 502-647-1160 (phone) ~ 502-647-1161 (fax)
John R. Leeper II, Principal ~ Donna Jones, Associate Principal
Angie Deckard, Assistant Principal ~ Chris Young, Assistant Principal
2015-2016 MLCHS Accelerated Academy Application
Personal Information:
Applicant’s Name: ___________________________________________________
Address: ______________________ City: ________________ Zip: ____________
Parent’s Name: _____________________________________________________
Parent’s Email: _____________________________________________________
Applicant’s Email: ___________________________________________________
Home Phone: _______________________ Cell Phone: _______________________
Career Pathway: __________________________
&
Spanish: ____ OR French: ____
Application Part One: Essays
Please attach essays on separate pages. Both essays 1 and 2 are required and are to be typed in Times
New Roman, 12 pt. font, double-spaced, and within the 500-750 word range for each essay.
1. Explain why you want to be a member of this program and how this opportunity fits your college and
career goals. How will your inclusion in the academy help you become a more productive member of
society? What specific qualities do you have that would enrich the academy environment?
2. The MLCHS Accelerated Academy seeks candidates who will be role models to their peers. This
includes a commitment to volunteerism. Explain what course of action you will take in order to earn your
annual 40 hours of volunteer/ service learning/ humanitarian work. What positive impact do you seek to
have as a result?
Application Part Two: Teacher Recommendation
A teacher recommendation is to be completed on the attached form. The teacher must be one of your 8th
grade core content teachers (Math, Science, Social Studies, or English).
Recommendation forms must be filled out by the teacher and submitted directly to Ms. Greenwell in
the Guidance Office.
801 Discovery Boulevard ~ Shelbyville, KY 40065 ~ 502-647-1160 (phone) ~ 502-647-1161 (fax)
John R. Leeper II, Principal ~ Donna Jones, Associate Principal
Angie Deckard, Assistant Principal ~ Chris Young, Assistant Principal
Teacher Recommendation Form
Teacher Name: ______________________________________________________________
Subject Taught: ____________________________
Student Name: ______________________________________________________________
Please check the number that represents your experiences with this student as related to the qualities listed
below. 5 will represent the highest score and 1 represents the lowest score.
Participation in class discussions/on task behavior in class
1
2
3
4
5
Self-discipline, responsibility, and dedication to follow
through
Motivation, initiative, and self-starting ability
1
2
3
4
5
1
2
3
4
5
Cooperation, social, and emotional maturity
1
2
3
4
5
Academic integrity and honesty
1
2
3
4
5
Consideration and attitudes toward others
1
2
3
4
5
Contributing member of the school community
1
2
3
4
5
In regards to academics, what are the greatest strengths and weaknesses of this student?
801 Discovery Boulevard ~ Shelbyville, KY 40065 ~ 502-647-1160 (phone) ~ 502-647-1161 (fax)
John R. Leeper II, Principal ~ Donna Jones, Associate Principal
Angie Deckard, Assistant Principal ~ Chris Young, Assistant Principal
Parent Statement of Commitment and Interest:
I understand and agree that if my son/daughter is accepted into the fifth cohort of the
Martha Layne Collins Accelerated Academy, that I will ensure the regular participation of
my child in all classes and coursework, for each of the four school years. I further realize
that my child must maintain high attendance, plus high levels of academic and behavioral
success to earn each additional year of participation within the Martha Layne Collins High
School Accelerated Academy.
________________________________________________
______________
Parent Signature
Date
Application Materials Checklist:
______ Personal Information
_______ Essays 1 and 2
_______ Teacher Recommendation
_______ Parent Statement of Commitment and Interest
*Grades, attendance, and behavior will also be considered. School will provide this
information with each student’s application.