Block ASI Application 2018
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ALTA SIERRA INTERMEDIATE SCHOOL
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BLOCK ASI AWARD 2017-18
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Name:Grade:AB Teacher:
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GENERAL REQUIREMENTS: Advisor (teacher or coach) or Learning Director (LD) must initial each activity completed below.
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PERSONAL CONDUCT: Any student who has been suspended from school shall not eligible for the Block ASI award.
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ATTENDANCE: Students with excessive tardies or unexcused absences, such that a referral to the School Attendance Review Board (SARB) has been made, shall not be eligible for Block ASI.
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MINDBODYSPIRIT
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Must complete at least 1 of these itemsMust complete at least 2 of these itemsMust complete at least 1 of these items
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SCHOLARSHIP1st SemesterLD's Initials
FITNESS & EFFORT
Check items completedAdvisor's InitialsSERVICECheck items completedAdvisor's Initials
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Principal's Honor Roll (4.0)Color GuardBruin of the Month
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High Honor Roll (3.76 to 3.99)Community Athletics/Dance Campus Beautification
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Honor Roll (3.50 to 3.75)(only if not offered at ASI)
(time log or verification form needed)
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All "A"s and "B"s (required)Fall AthleticsCommunity Service
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Total SCHOLARSHIP Items:
Meet "Healthy Fitness Zone"
(time log or verification form needed)
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(PFA Testing in P.E.)PASA
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CO-CURRICULARPep & CheerPerforming Arts
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Must complete at least 2 of these items
Check items completedAdvisor's InitialsSpring AthleticsParade/Performance
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Art or Writing Contest (May only use one)Winter Athletics(if participation isn't part of regular class credit)
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Winter PercussionRun for Student Leadership Office
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ASI Student Body Drama Production
Total BODY Items:
(can only be used if not checked in Co-Curricular)
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County or State Honor Group (Music)
Total spirit Items:
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Destination ImaginationAWARD POINT SUMMARY
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Math CountsCategory
Required
Completed
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Regional History DayMIND - Scholarship1 q Student HAS met ALL Block ASI requirements
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Regional Science FairMIND - Co-Curricular2
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Regional Science OlympiadBODY - Fitness & Effort2 q Student has NOT met ALL Block ASI requirements
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RoboticsSPIRIT - Service1
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Run for Student Leadership Office (can only be used if not checked in Spirit)TOTAL ITEMS:6
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Science Bowl
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Total CO-CURRICULAR Items:
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Parent's Signature:Student's Signature:
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