Health Academy Application 2018

Email address *
Be part of our Blue and Green team!
Application Instructions
Thank you for your interest in the CVHS Health Academy.

1. Complete entire application.
2. The academy Lead will contact you for an interview.
3. You will receive an invitation for interview.
4. For the interview, be prepared to respond to questions about yourself, including interests, strengths and weaknesses.

Student Name Last, First
Your answer
Student ID (5 digit #)
Your answer
Graduating Class Year
Your answer
CVHS Counselor
Your answer
Mobile phone number
Your answer
Email *
Your answer
Current Class Schedule
Per. 1 * Teacher * Class * Rm # * Grade
Your answer
Per. 2 * Teacher * Class * Rm # * Grade
Your answer
Per. 3 * Teacher * Class * Rm # * Grade
Your answer
Per. 4 * Teacher * Class * Rm # * Grade
Your answer
Per. 5 * Teacher * Class * Rm # * Grade
Your answer
Per. 6 * Teacher * Class * Rm # * Grade
Your answer
Teacher References
Teacher References. You must obtain two (2) teacher references. Teacher may type directly onto this form. References will be confirmed. 1 = unmentionable, 2 = average, could be better, 3 = probably among the best possible.
MM
/
DD
/
YYYY
Name & rm # of Teacher
Your answer
Aptitude "productive and capable"
Attendance "nearly always here"
Attitude "cooperative and non-confrontational"
Citizenship & Image "a positive CVHS representative"
Please provide commentary about this student.
Your answer
Parental Consent: I give my child permission to apply to the CVHS Health Academy. TYPE parent / guardian name below. *
Your answer
Parent / Guardian mobile#
Your answer
Do you have missing credits?
Do you need to improve D grades in previously completed courses [to meet the A-G requirements]?
Would you be willing to participate in an afterschool peer tutoring program to improve your grades, or help others with theirs?
Would you be willing to participate in a student leadership role within the academy?
Do you have a specific career goal in mind at this time? If yes, write it in next question.
My main reason for applying to the Health Academy is
Your answer
My 2nd choice, if I am not accepted into the Health Academy would be
If you were referred by a Health Academy student, LIST their name here.
Your answer
A copy of your responses will be emailed to the address you provided.
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