THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
CENTER FOR MATH AND PHYSICAL SCIENCES
Application Checklist : Student’s Name: _________________________ (print)
_____ 1. Complete the two-page application form and make sure that the student and
parent/guardian both sign and date the form
______ 2. Read the VHSL eligibility regulation and make sure that the student and
parent/guardian both sign and date the form
______ 3. Make a copy of the student’s first semester (or most recent) report card.
______ 4. Give a copy of the teacher recommendation form to TWO of the student’s
current teachers (math, science or language arts teachers). Have the teachers
complete the form and return it to the Cambridge Program Coordinator at
Potomac Senior High School by February 13. If materials are mailed, they must
be postmarked by February 13.
Complete items 5 & 6 if Potomac Senior High School is NOT the base school.
______ 5. If Potomac Senior High School is NOT the base school for the student,
complete the top half of a transfer request form (not included in this packet,
available at any PWCS school). Do NOT take the Transfer Request Form to the
base high school for the principal’s signature. Potomac will forward the form to
the appropriate base school.
______ 6. If Potomac Senior High School is NOT the base school for the student,
complete the Express Bus Form information. The listed bus stops are
tentative. Please choose the most convenient bus stop for your student.
______ 7. Mail or deliver the application form, VHSL eligibility form, copy of the
report card, and Transfer Request and Bus Forms (when applicable) to:
Dr. Sally B. Kenavan
Cambridge Coordinator
Potomac Senior High School
3401 Panther Pride Drive
Dumfries, VA 22026
ALL PORTIONS OF THE APPLICATION MUST ARRIVE AT POTOMAC
SENIOR HIGH SCHOOL OR BE POSTMARKED BY FEBRUARY 13.
An incomplete application packet may prevent a student from being considered for
participation in the Cambridge Program.
THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
Dr. Sally B. Kenavan
Cambridge Coordinator
3401 Panther Pride Drive
Dumfries, VA 22026
Website: http://potomac.hs.groupfusion.net
Website: www.cie.org.uk
email: kenavasb@pwcs.edu
Telephone (703) 441-4200
Fax (703) 441-4497
www.potomacpanthers.org
STUDENT APPLICATION FORM
To be eligible for the Cambridge Program, students must have a recommendation from a Language Arts, Mathematics,
or Science teacher and a “B” or better for the first semester in prerequisite courses.
Date ________________________________
Grade (next year)________________
Student’s Name ___________________________________ DOB ___________ Male _______Female _______
Address __________________________________City ________________State______ Zip Code ___________
Home Telephone ____________________________ E-mail Address ___________________________________
Name of Parent(s) or Guardian(s) (please print)_____________________________________________________
Father’s Work No. __________________________ Mother’s Work No. _________________________________
Name of Current Middle/High School _______________________________ Student ID #__________________
Will your son or daughter require any special services while attending Potomac Sr. H.S.? ______YES
______NO
Name of Base High School _____________________________________________________________________
List all specialty programs to which you have applied (including this one) in order of preference. Put a #1 by your first choice, a
#2 by your second choice, etc. If you meet the qualifications for your first choice, you will be accepted into that program only.
If you are not accepted into your first choice, you will be considered for your second choice, etc. If applying to more than one
program, the order of preference needs to be the same on each application. You will receive only one letter of acceptance to
a specialty program, which will be mailed in March.
_____ Cambridge Program Center for Math and Sciences – Potomac Senior High School
_____ Center for Environmental Science (CENS) Program – Freedom High School
_____ Center for the Fine and Performing Arts – Woodbridge Senior. High School
_____ Center for International Studies and Languages (CISL) Program – C.D. Hylton High School
_____ International Baccalaureate (IB) Program – Gar-Field High School
_____ Information Technology (IT) Program – Forest Park High School
_____ The Biotechnology Center-Osbourn Park High School
Deadline for Application: February 13
THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
Student Application Form: Anticipated Areas of Study
Student’s Name:_________________________________________(print)
Choose one:
*AICE Diploma Program ________
*Cambridge Certificate Program ________
The AICE Diploma Program is designed for those students interested in a comprehensive
program with an accelerated, international curriculum. They must take external examinations in
six AICE level courses by the end of their senior year. These students anticipate fulfilling all the
requirements for the AICE Diploma upon graduating.
The Cambridge Certificate Program is designed for those students interested in taking at least
one Cambridge course each year. They may take the external examinations in the Cambridge
courses at the end of each year and earn certificates of achievement.
*This choice may be changed at any time throughout the student’s four years of high school.
Enrollment Contract
Program Requirements:
1.
Cambridge students are required to take at least one Cambridge course in a sequence
each year.
2.
Cambridge students are expected to have high academic expectations, be selfmotivated, and have good study habits.
3.
Cambridge students must demonstrate a commitment to succeed in this rigorous
program.
We, the undersigned, understand the expectations and requirements for the Cambridge
Program. We request that all data in support of this student’s application for the
Cambridge Program be sent to the Cambridge Coordinator at Potomac Senior High
School.
__________________________________________
______________
Parent/Guardian Signature
Date
______________________________________________
Student Signature
Deadline for Application: February 13
_______________
Date
THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
Student’s Name___________________________________________________________ (print)
Regulation 721-1
Virginia High School League Eligibility
Specialty School Transfer Regulation
Rising ninth grade students who transfer to a school to participate in a specialty program will be eligible
for VHSL sponsored activities for athletic/activity participation. The transfer must occur at the beginning
of the program. The student must meet full participation requirements of the program to retain eligibility.
Rising tenth and eleventh grade students who transfer to any specialty program who wish to
participate in VHSL activities MUST submit in writing a written request for eligibility with their
application.
If a student withdraws or is dismissed by the program director from the specialty program, once the
withdrawal procedure is completed, the student must return to his/her base school.
If a student withdraws from the specialty program on or before October 15, the student will be ineligible
for participation in VHSL sponsored activities for the remainder of the first semester, but eligible for
participation for the second semester. If a student withdraws from the specialty program after October 15,
but before the end of the first semester, the students will be ineligible for participation for the remainder
of that school year. Eligibility will be restored at the base school at the beginning of the fall season of the
next school year.
If the student withdraws during the second semester of a school year, the student will be ineligible for the
next fall semester. If a student withdraws from the specialty program after one school year, the student
will return to his/her base school and will be ineligible for one year.
Parent/Student Commitment: We have read the above information and understand that
enrollment in this program entails compliance with VHSL regulations as it pertains to
athletic/activity participation.
Parent/Guardian Signature ____________________________________Date _______________
Student Signature ____________________________________________Date _______________
The Prince William County Public School Division does not discriminate in employment or in its educational program and activities
against qualified individuals with disabilities, nor on the basis of age, gender, race, color, religion or national origin.
Deadline for Application: February 13
THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
Teacher Recommendation Form
Teachers: Please complete the information requested below. Return this form to the Cambridge
Coordinator at Potomac Senior High School, 3401 Panther Pride Drive, Dumfries, VA 22026 by February
15.
Student’s Name _________________________________________________________________
Current Middle/High School _______________________________________________________
Print:
____________________________________________
Teacher
Signature:
____________________________________________
Teacher
Choose one:
_______Language Arts/English teacher (Grade Level:_______________)
______ Mathematics teacher (Course name: ______________________)
______ Science teacher (Course name: __________________________)
Student’s first semester grade ____________________________
Evaluation:
Category
Top 5%
Above Average
Average
Below Average
No Basis for
Judgment
Academic Ability
Motivation/SelfDiscipline
Self-Confidence
Ability to Work
with Others
Leadership
Respect for
Classmates
Respect for
Faculty
Comments:
Recommendation: (Choose one)
Strongly Recommend ______
Recommend ______
Deadline for Application: February 13
Not Recommend ______
THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
Teacher Recommendation Form
Teachers: Please complete the information requested below. Return this form to the Cambridge
Coordinator at Potomac Senior High School, 3401 Panther Pride Drive, Dumfries, VA 22026 by February
15.
Student’s Name _________________________________________________________________
Current Middle/High School _______________________________________________________
Print:
____________________________________________
Teacher
Signature:
____________________________________________
Teacher
Choose one:
_______Language Arts/English teacher (Grade Level:_______________)
______ Mathematics teacher (Course name: ______________________)
______ Science teacher (Course name: __________________________)
Student’s first semester grade ____________________________
Evaluation:
Category
Top 5%
Above Average
Average
Below Average
No Basis for
Judgment
Academic Ability
Motivation/SelfDiscipline
Self-Confidence
Ability to Work
with Others
Leadership
Respect for
Classmates
Respect for
Faculty
Comments:
Recommendation: (Choose one)
Strongly Recommend ______
Recommend ______
Deadline for Application: February 13
Not Recommend ______
THE CAMBRIDGE PROGRAM
POTOMAC SENIOR HIGH SCHOOL
AREAS DE ESTUDIO DISPONIBLE
Escoja uno de los siguientes programas:
*Diploma del programa AICE_________
Certificado del programa Cambridge_______
Diploma del programa AICE: está diseñado para los estudiantes interesados en un programa
comprensivo con un currículo internacional acelarado. Los estudiantes deben tomar seis
examenes del programa AICE en las asignutaras ofrecidas antes de terminar su último año en la
escuela secundaria. Para obtener el diploma del programa AICE los estudiantes deben
completar todos los requisitos del programa AICE (seis cursos) y aprobar los examenes del
mismo.
Certificado del programa Cambridge: está diseñado para los estudiantes interesados en tomar
uno o más cursos de este programa cada año. Los estudiantes pueden tomar examenes del
programa Cambridge al final de cada año y obtener un certificado indicando que aprobó exitoso
el examen.
* Estas opciones se pueden cambiar en cualquier momento del año, durante los cuatro años que
el estudiante esté en la escuela secundaria.
Contrato de Matrícula
Requisitos del Programa
1.
Los estudiantes inscritos en el programa de Cambridge tienen que tomar aunque sea un
curso de este programa cada año.
2.
Los estudiantes inscritos en el programa de Cambridge deben mantener un alto índice
académico, tener iniciativa y buenos hábitos de estudio.
3.
Los estudiantes inscritos en el programa de Cambridge deben mantener su
compromiso de estudio para tener éxito en este riguroso programa.
Nosotros, los firmantes, entendemos las expectativas y requisitos del programa de Cambridge.
Solicitamos que toda la información en la aplicación del programa de Cambridge de mi
acudido(a), se le envie al coordinador(a) del programa de Cambridge a Potomac Senior High
School.
__________________________
___________
Padres/Acudiente
Fecha
___________________________
Firma del estudiante
___________
Fecha