ADMISSIONS INFORMATION &
APPLICATION PACKET
For academic year
2014-2015
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
ADMISSIONS POLICIES
Metrolina Regional Scholars Academy admissions policies are established to support the School’s vision: a
learning community dedicated to providing the most appropriate educational challenges for highly intellectually
gifted students in a flexible environment that offers emotional and social support, and fosters self-acceptance,
join in learning, a celebration of diversity and a desire to be of service.
The Scholars Academy is currently accepting applications for the 2013-2014 school year. Students who score
at three or more standard deviations above the mean on an individualized cognitive abilities test are
automatically included in the eligibility pool. Applications with a score two standard deviations above the mean
are reviewed by the School Based Assessment Committee to determine eligibility.
APPLICATION DEADLINE: JANUARY 31, 2014
GROUP TEST DEADLINE: DECEMBER 13, 2013
Completion of this form and submission of evidence of giftedness do not guarantee admission. Admission is
based on test scores, nomination forms, and space available in grade/class lottery.
All completed applications will be reviewed by the admissions committee. Our primary admissions
goal is to determine if a child can and will be successful at Scholars Academy based on our Charter.
Once that is determined, all qualified children are entered into the lottery, where the drawing takes
places publicly on February 25, 2014. Qualified siblings are given priority, although a seat cannot be
guaranteed. After a grade level is filled, the school will maintain a wait list. Students on this wait list
will be ranked according to the lottery. If an opening occurs, the school will contact the family to
offer them the open seat. The wait list starts fresh at every lottery.
Scholars Academy does not discriminate on the basis of sex, race, color, religion, sexual orientation or national
origin in the administration of its educational programs, admissions policies, employment practices, or schooladministered programs.
Please note that all students attending Scholars Academy must be fully immunized unless they qualify for a
medical exemption under North Carolina law.
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
APPLICATION INFORMATION
For each child you wish to attend, please complete the following:
Application Form
Parent Nomination Form
Student Nomination Form (current 3rd grade and above)
Group Test Application, if applicable
Three Proofs of North Carolina Residency
Testing Verification Form from parent/guardian
Testing Verification Form from testing professional (parents provide to tester
at time of testing, to be sent with testing results)
8) Teacher Nomination Form: Ask your child’s current teacher to complete and
send directly to the Scholars Academy
9) Obtain your child’s test results from cognitive abilities or IQ tests
1)
2)
3)
4)
5)
6)
7)
OR
Arrange to have your child tested individually by a licensed psychologist. The
testing report MUST come directly from the psychologist. The reports should
be faxed to 704-503-1183, attn: Admissions. The school provides a one-time
group test option.
Your application must have all components before it is considered complete. Call the
School at 704-503-1112, if you need additional information. Enclose these forms in an envelope
and mail to:
Metrolina Regional Scholars Academy
5225 Seventy-seven Center Drive
Charlotte, NC 28217
If your child will not be five years old before August 31, 2013, please call the school for
additional information and requirements.
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
APPLICATION FORM
Family and Biographical Information
Student’s Name
First
Middle
Last
Preferred
Home Address
Street
City
State
Zip
County
Date of Birth
Age as of August 31, 2014
Home Phone
Current grade
Parent E-mail
School Attending 2013-2014
Father’s Name
First
Middle
Last
Preferred
Home Address
If different from student
Street
City
State
Zip
County
Mother’s Name
First
Middle
Last
Preferred
Home Address
If different from student
City
Street
State
Zip
County
How did you hear about the School?
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
PARENT NOMINATION FORM
Student’s Name
First
Current Grade
Middle
Age
Last
School Attending
Preferred
Date
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
Often remembers things with a great
deal of detail
1
2
3
4
5
Often knows how to do something
after FIRST demonstration (needs
no or little re-teaching)
2
3
4
5
1
1
2
3
4
5
Persists on projects even when s/he
has a setback
1
2
3
4
5
Applies his/her knowledge in new,
unique situations
1
2
3
My Child:
Surprises me with the extent of
his/her knowledge either about a
single topic or in general
5
4
Persistently demands reasons for
questions that intrigue him/her
1
2
3
4
5
Suggests original ways of doing
things
1
2
3
4
5
Likes to play with ideas
1
2
3
4
5
Finds humor in things other children
don’t find funny
1
2
3
4
5
Is highly curious about the future,
the unknown, and the connections
between events
1
2
3
4
5
Gets so involved with an idea or
project that s/he focuses on it to the
exclusion of other activities
1
2
3
4
5
Sets high personal goals and is
frustrated when s/he cannot meet
those goals
1
2
3
4
5
1
2
3
4
5
Likes to absorb as much information
as she/he can about topics that
interest him/her and actively
pursues new information on that
topic
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
PARENT NOMINATION FORM - CONTINUED
Describe any ways your child is different from his/her peers.
Describe your child’s relationship with others.
Describe how your child feels about reading.
What does your child do with his / her free time?
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
SELF NOMINATION FORM
Student’s Name
First
Current Grade
Middle
Age
Last
School Attending
Preferred
Date
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
I learn most things the first time
they are explained
1
2
3
4
5
I enjoy discussing / debating
ideas
1
2
3
4
5
I like to solve problems in
unique and unusual ways
1
2
3
4
5
I see humor in things other kids
don’t
1
2
3
4
5
Other people think I am
Intelligent
1
2
3
4
5
I have a good memory
1
2
3
4
5
I can take things apart and put
them back together
1
2
3
4
5
I enjoy being around older kids
and adults
1
2
3
4
5
Kids my age often don’t
understand my ideas
1
2
3
4
5
My Child:
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SELF NOMINATION FORM - CONTINUED
What is your favorite subject? Why?
What are the titles of some of your favorite books? Why are they your favorites?
How do you like to spend your free time?
What have you done that most children your age haven’t done?
Why do you need a special school?
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
GROUP TEST APPLICATION
Student’s Name
First
Middle
Last
Home Address
Street
City
Date of Birth
Home Phone
Alternate Phone
State
Zip
County
Current grade
Parent E-mail
Alternate E-mail
In order to be eligible for the school tests, you must have a completed application on file at
Scholars Academy by December 13th, 2013.
I acknowledge that a group that a group testing situation can be stressful for very young
children. I agree to follow the directions of the test administrator at Scholars Academy
concerning my child’s participation in these tests.
Group testing will be held on Saturday, January11th, 2014 from 9:00 am – 11:00 am at
Metrolina Regional Scholars Academy, 5225 Seventy-seven Center Drive, Charlotte, NC
28217.
Parent Signature
Date
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
RESIDENCY REQUIREMENT FOR STUDENTS
In order to submit an application and attend Metrolina Regional Scholars Academy, a student
must be a resident of North Carolina at the time of submitting an application. The residence of a
child under age 18 is the legal residence of the parent(s) or guardian(s) who has physical
custody of the child.
“Residence” is the place where a person lives permanently. Temporary residence in North
Carolina, solely for the purpose of applying and attending Scholars Academy, is not considered
“residency”.
Verification of North Carolina Residency
Before any student is assigned to or invited to attend Scholars Academy, his/her parent or legal
guardian must provide at least three proofs of residency in North Carolina. Documents must
be pre-printed with the name and address of the student’s parent or guardian and must be
presented to the office at the time of submitting the application. Please note that legal
guardianship requires additional documentation from a court or agency.
These documents are also required for any change of address.
Applicants must submit at least one document from each of the following three groups:
Group A

Copy of deed AND record of most recent mortgage payment*

Copy of Lease (including BHA and HUD leases) AND record of most recent rent
payment*

Legal affidavit from landlord affirming tenancy AND record of most recent payment*

Section 8 agreement

Property tax bill

Print out of property information from the county tax information website**
* You must submit BOTH of these documents
** The website for the counties are:

Mecklenburg - http://polaris.mecklenburgcountync.gov

Union - http://maps.co.union.nc.us

Gaston - http://www.co.gaston.nc.us/maps

Lincoln - http://www.lincolncounty.org/index.aspx?nid=290

Cabarrus - http://gis.cabarruscounty.us

Stanly - http://www.stanlygis.net

Rowan - http://rowan.ustaxdata.com

Iredell - http://www.co.iredell.nc.us
RESIDENCY REQUIREMENT FOR STUDENTS - CONTINUED
Group B
A utility bill or work order dated within the past 60 days:
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217





Gas bill
Oil bill
Electric bill
Home telephone bill*
Cable bill
* We do not accept cell phone bills.
If a family is sharing housing with an individual or family and does not pay rent, the family may
submit a utility bill in the name of the person who owns or leases the property.
Group C




Valid NC driver’s license
Current vehicle registration
Valid NC photo identification card
Valid passport
Dated within the past year:

W-2 form
Dated within the past 60 days:

Letter from an approved government agency

Payroll stub

Bank or credit card statement
Any student found to be in violation of the residency policy will be dismissed immediately from
the Scholars Academy. The parent/guardian of a student dismissed for non-residency may
appeal the decision. The student may be allowed to remain in school during the appeal
procedure.
In addition to dismissal from school, the Scholars Academy may impose penalties on the family
such as legal action or a fine based on the cost of educational services received.
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
TEST VALIDITY VERIFICATION FORM: PARENT
Intelligence tests scores compare your child’s scores on various cognitive tasks with other
children the same age. An important assumption is that the children have no prior experience
with the tasks. Intelligence test results are invalid if the child has taken the same test in the past
year or has used a “practice kit” designed to simulate the tasks. If your child has already taken
an IQ test in the past year or has practiced with a test kit, then you must use a different test.
The best way to prepare your child for the intelligence test tasks is to offer a verbally and
nonverbally stimulating environment by talking with your child, reading with your child, asking
questions, making observations, and engaging with your child’s surroundings.
Child’s name
First
Middle
Current IQ test
Last
Date of Test
Psychologist
Please report your child’s previous testing experience:
This is my child’s first intelligence test and my child did not receive any special preparation
for this test.
My child has taken this test before, but the date was at least one year prior to the current
test date. Previous test date(s)
My child has taken a different test before, but not this one.
Previous test date(s)
My child used a test preparation kit designed to improve scores on a different IQ test
(note: use of these kits invalidates the child’s scores on that test at any point). My child did not
use a preparation kit for the current test.
Parent Signature
Date
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
TEST VALIDITY VERIFICATION FORM: PSYCHOLOGIST
(provide to psychologist at time of testing)
Child’s name
First
Current IQ test
Middle
Last
Date of Test
To the best of my knowledge, this child has not taken this IQ test in the past year, nor did
they report any prior knowledge of or experience with specific test materials.
This child’s comments or pattern of responses suggests that they may have prior
knowledge of or experience with specific test materials.
Please explain:
Psychologist Signature
Date
Psychologist Name Printed
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
SCHOLARS ACADEMY
TEACHER NOMINATION FORM
Student’s Name
First
Current Grade
Age
Middle
Last
School Attending
Date
Teacher’s Signature
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
1
2
3
4
5
Often knows how to do something
after FIRST demonstration (needs
no or little re-teaching)
1
2
3
4
5
Surprises me with the extent of
his/her knowledge either about a
single topic or in general
1
2
3
4
5
Persists on projects even when s/he
has a setback
1
2
3
4
5
Applies his/her knowledge in new,
unique situations
1
2
3
4
Persistently demands reasons for
questions that intrigue him/her
1
2
3
4
5
Suggests original ways of doing
things
1
2
3
4
5
Likes to play with ideas
1
2
3
4
5
Finds humor in things other children
don’t find funny
1
2
3
4
5
Is highly curious about the future,
the unknown, and the connections
between events
1
2
3
4
5
Gets so involved with an idea or
project that s/he focuses on it to the
exclusion of other activities
1
2
3
4
5
Sets high personal goals and is
frustrated when s/he cannot meet
those goals
1
2
3
4
5
1
2
3
4
5
This Child:
Often remembers things with a great
deal of detail
Likes to absorb as much information
about topics that interest him/her
and actively pursues new
information on that topic
5
TEACHER NOMINATION FORM - CONTINUED
What is the student’s achievement/grade level in:
Reading
Math
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
How long and in what capacity have you known this student?
Metrolina Regional Scholars Academy is a public charter school that offers full time educational programming to meet
the needs of highly gifted children ages 5-13. Students will explore the curriculum at a faster pace and in greater
depth and complexity than is typically possible in a regular classroom.
Information on this form is confidential between the teacher and the admissions committee of the Scholars Academy
and will not be revealed to parents without written consent from the teacher.
Do you think this child needs a special program for highly gifted children? Why? or why not?
Please describe the social/emotional development of this child.
What other information do you think we need to know about this child?
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217
Testing Information
Testing should be done by a Licensed Psychologist or Licensed Psychological Associate who
have experience completing intellectual assessment.
Tests accepted by The Scholars Academy for the purpose of admissions are:
Stanford Binet Intelligence Scale V
Wechsler Intelligence Scale for Children IV (WISC IV)
Wechsler Preschool and Primary Scale of Intelligence III or IV (WPPSI III or IV)
A psychologist in your area can be found on either of these websites or through a general
internet search.
Mecklenburg Psychological Association: mpacharlotte.org
Psychology Today: psycologytoday.com
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Metrolina Regional Scholars Academy · 5225 Seventy-seven Center Drive · Charlotte, NC 28217