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Ferguson High School Application
Applicant Introduction
Ferguson High is designated an Alternative Education Campus (AEC) by the Colorado Department of Education. This designation means 90% or more of our students fall into at least one of the at-risk categories identified by Colorado Statute (SB 09-163). Questions in this application help determine if a student qualifies in one or more of these categories and if they are a good fit to join the Ferguson community.

Grade Level Requirements and Graduation Requirements:
To be considered for admission to Ferguson High School, students must be in 9th-12th grade. Students at Ferguson High School must fulfill the graduation requirements set forth by the Thompson School District to receive their diploma.

Application Process:
In order to be placed on our waiting list, students must do the following:
1. Submit (online) a completed application form and send all previous transcripts, including immunizations to the attention of Carol Hetzel at 1101 Hilltop Drive, Loveland, CO 80537.
2. Schedule and successfully complete an interview and orientation. Parents are required to attend the orientation.

First Name *
Your answer
Nick Name
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Student Date of Birth (mm/dd/yyyy) *
MM
/
DD
/
YYYY
Gender *
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone Number
Your answer
Student Cell Phone Number *
Your answer
Parent/Guardian Name *
Your answer
Relationship (Example: mother, stepmother, grandparent, etc.) *
Your answer
Parent/Guardian cell phone *
Your answer
Parent/Guardian Email *
Your answer
Student: Are you currently employed? *
If yes, where are you employed?
Your answer
Current Supervisor's Name
Your answer
Student: Do you have a valid Colorado Driver's License? *
If yes, what is your Driver's License number?
Your answer
Will you be driving a vehicle to school? *
If yes, what is the make, model, color and license plate number of your car?
Your answer
Are you currently attending school? *
Most recent grade attended: *
I am currently receiving services on one or more of the following learning plans: (Check all that apply) *
Required
Name of most recent high school attended: *
Address and Phone number of last high school attended if it NOT a Thompson School District School
Your answer
Other high schools attended: *
Required
Are you currently enrolled in an online class with a Thompson School District School *
If yes, what class(s) and who is your teacher.
Your answer
Evaluate Your Skills: Reading *
Evaluate Your Skills: Writing *
Evaluate Your Skills: Math *
Have you ever been expelled from school? *
If yes, for what reason(s)?
Your answer
Have you ever been suspended from school? *
If Yes, for what reason(s)?
Your answer
Do you have multiple in-school or out-of-school suspensions? *
When was the onset of your school behavioral issues? *
Do you have, or ever had, attendance issues? (Excused, unexcused, tardies, missed periods) *
If yes, for what reason(s) were you absent?
Your answer
Do you have a history of truancy? *
When was the onset of your truancy issues? *
Have you had contact with any law enforcement agencies in the past 6 months? (This includes law enforcement agencies outside of Thompson School District) *
Have you ever been arrested? *
If yes, for what reasons(s)?
Your answer
Are you currently on probation? *
If yes, for what reason(s)?
Your answer
Name of Probation Officer
Your answer
Phone number of Probation Officer
Your answer
Do you have a history of substance use/abuse (current or in the past)? *
Onset of personal drug and/or alcohol involvement? *
Is there a history of drug use or abuse in your family? *
Is there a history of violence in your home? *
Do you have a diagnosed psychological or behavioral disorder? *
Have you ever underwent a threat or suicide assessment? *
Have you ever dropped out of school? *
When was the onset of your school academic issues? *
Are you a parent? *
If yes, what is the age of your child?
Your answer
If expecting, when is your due date?
MM
/
DD
/
YYYY
Are you, or have you ever been homeless? *
Required
Have you experienced any grief or loss? *
If yes, share a short description of the grief or loss concern(s).
Your answer
Have you experienced a traumatic event? (major accidents, health problems of a family member, your own health problems, witness to a traumatic event, etc.) *
If yes, share a short description of the traumatic event(s)
Your answer
Please check any interventions that apply to your background (check all that apply) *
Required
With whom are you currently living? *
Your answer
How would you describe your relationship with your parents? *
Your answer
Describe a positive high school experience. *
Your answer
Describe a negative experience in high school. *
Your answer
What do you like to do when you are not at school or work? *
Your answer
What else would you like us to know about you? *
Your answer
How did you learn about Ferguson High School? *
Your answer
What do you think you can contribute to our school? *
Your answer
Why do you want a high school diploma? *
Your answer
What do you hope to do after you graduate from high school? *
In a short paragraph, explain why coming to Ferguson High School will allow you to be successful with attending your life goals. *
Your answer
Type your first and last name here. Your signature indicates that all of the information you have provided in this packet is correct and was completed by you. Any misleading or false information of this form will result in immediate removal from Ferguson High School waiting list, and/or immediate dismissal from Ferguson High School. *
Your answer
If you have a question or special need, please include below.
Your answer
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