YAMPAH MOUNTAIN HIGH SCHOOL

INTERIM TRIP APPLICATION

THE FOLLOWING APPLICATION IS REQUIRED TO BE SUBMITTED PRIOR TO ACCEPTANCE ON ANY INTERIM TRIPS. INTERVIEWS WILL BE CONDUCTED AFTER SUBMISSION OF APPLICATION. STUDENTS WILL BE NOTIFIED OF ACCEPTANCE ON INTERIM TRIPS AFTER AND ARE NOT PERMITTED TO ATTEND PRIOR

INTERIM TRIP OFFERINGS: Trimester______ Year_____

STUDENT NAME :_________________________________

OFFERINGS: PLEASE LABEL YOUR CHOICE PREFERENCES STARTING WITH 1 AS YOU FIRST CHOICE.

PREFERENCE 

INTERIM TRIP OFFERINGS

$ COST

This sounds fun!

APPLICATION QUESTIONS (ALL REQUIRED)

  1. Have you participated in other interim experiences?  YES     NO

 If yes, please list:

  1. Why do you want to go on your first choice interim?

  1. What are your expectations of the interim?

Please specify:

  1. Can you pay for the entire cost of the  trip?      Yes        *No   

IMPORTANT: Cancellation within 10 days of trip may not be refundable.

If *No,  what can you afford to pay?  _________  How else could you contribute to the cost of the trip?

  1.  How are you doing in school, currently at Yampah? Please address attendance, grades, work completion, behavior and  participation in your response:

  1. Do you have any legal issues that would impact your ability to participate in an interim?      Yes      No.       If yes, please explain further:

  1. Have you had or do you have any drug or alcohol issues that might impact your participation on an interim experience?    Yes     No      If yes, please explain further:

  1. Have you had a drug or alcohol infraction, or participated in a drug passage at school?  YES     NO

 If yes, explain what happened:

  1. Do you have any work, school (CMC) or other personal issues that might impact your participation on an interim experience?    Yes     No      If yes, please explain further:

  1. What questions do you have?

  1. We take drug, alcohol and other student conduct expectations very seriously, with specifically heightened responses on interim trips to ensure the safety of all. Please sign this application, that you understand that you personal belongings are subject to search if concerns are suspected and that any drug, alcohol or substance issue will result in being sent home from the trip at the cost to the student and family. No refund on trip will be issued and violation may result in dismissal from Yampah Mountain High School:

I understand this policy and requirements of interim participation:___________________________

                                                                                                   Student Signature

*Parent/Guardian Contact:_______________________________________________

                                             Name                                                phone number                                  email                                         

*If accepted for the interim, parent/guardian will be called for recommendation & permission.

The final part of the application is your Advisor recommendation. Please give this completed application to your Advisor:

I recommend this Advisee for participation on the interim of their choice:   YES       NO      UNSURE

Advisor Signature_______________________________ Date: __________________

ADVISOR NOTES:


SOLSHINE FUND

SCHOLARSHIP APPLICATION

THE FOLLOWING APPLICATION IS IS OPTIONAL FOR STUDENTS WANTING TO APPLY TO THE ANNUAL $100/STUDENT SOL FUND ACCOUNT. PLEASE NOTE: STUDENTS MAY ALSO “BANK” FUNDS AND BE ELIGIBLE FOR ADDITIONAL AMOUNT IN FUTURE YEARS

(I.E. 2ND YEAR STUDENT THAT DID NOT APPLY FOR $100, COULD APPLY FOR $200)

STUDENT NAME :_________________________________

SOLSHINE FUND SCHOLARSHIPS ARE MERIT-BASED (AS OPPOSED TO FINANCIAL NEED). CRITERIA FOR ELIGIBILITY ARE BASED ON PARTICIPATION IN THE YMHS SCHOOL COMMUNITY--

PRINCIPLES OF THE SCHOOL:

RESOURCES DEDICATED TO LEARNING AND A TONE OF DECENCY & TRUST

Amount of request ($100/annual): __________________

Interim Choice for Scholarship: ____________________

ENROLLMENT STATUS

ATTENDANCE

Eligibility

CREDIT ACQUISITION

I understand the drug and alcohol policy and any issues with substances on an interim will result in my needing to pay back scholarship awards issued. SIGNED (Student): ___________________________________

                  (Principal)

                  ________________________________________________________ Date: _____________

                  (Student’s Advisor)

     ________________________________________________________ Date: _____________

                  (Student)