We’re excited that you’re interested in exploring The Community Year (TCY) as an option for your high school career. Filling out and submitting this application is the first step in the process. Once we receive your completed application, we’ll contact you to schedule an interview. The interview is an opportunity for us to get to know one another, for you to ask any questions you have about the program, and for us to collectively determine if this will be a good fit for you as a learner. If you have any questions as you are filling out this form, do not hesitate to contact us. You can find our contact information at the bottom of this form.

First Name: Last Name:

Name you commonly go by (if different than first name):
 
Gender:  Male Female

Age:                   Birth date (mm/dd/yyyy):

Home address:

City/Town:        State               Zip code:

Home phone:  

Other/cell phone number:

E-mail:

How did you hear about The Community Year?

___________________________________________________________________________________

Name of Parent/Guardian #1:

Address (if different from applicant’s): Town:

State: Zip:

Home phone:     Cell/other phone:

E-mail:

Name of Parent/Guardian #2:

Address (if different from applicant’s): Town:

State: Zip:

Home phone:     Cell/other phone:

E-mail:

Current School Information

Present grade in school: 8 9 10 11 12

School name:

School phone:

Name of your guidance counselor / advisor:

* Please a copy of your most recent transcripts (Please see Transcript Request form on our website). You may also mail or drop your transcrips off at the CCLC - 10 Commissary Point Road, Trescott, ME 04652

References:
Please provide the names and contact information of two people who can speak to the likelihood of your success in the Community Year program. References should be someone who knows you as a student: administrators, teachers, counselors, etc. Please notify these references that they will be contacted by the CCLC.

Reference #1: E-mail: Work phone:

Reference #2: E-mail: Work phone:

Written Responses:

To the student: We would like to learn more about you through your answers to the questions below. We are looking for developed answers as a way to get a sense of who you are and if this program will be a good fit for you. We encourage you to reflect on what is important to you and allow your responses to communicate who you really are. In short, be yourself!

Please complete the following sentences:
I am happiest when

Three adjectives that describe me best are

In my free time, I like to

My favorite way to learn is

Someday I would like to

It is recommended that you use a word processing program such as "Word" to compose your answers to the questions below, so you can save your work. You can then copy your text, and paste it into the fields below.

1. Based on what you know about the CCLC, and from what you have read in the brochure or on our website, explain why you want to participate in The Community Year. What excites you? What might challenge you?


2. Each participant in TCY will be an important member of our group. What qualities, talents or gifts would you contribute to our learning community?


3. Share with us an idea or topic you've learned about and found particularly interesting.


4. What qualities do you value in your friends?


5. What are your greatest strengths? What are your greatest challenges?


6. Tell us about your favorite book you've read outside of school. Why is it your favorite?


7. What goals to you hope to achieve by the end of The Community Year?


8. Please describe if you have any special dietary, physical, academic or emotional needs that you would like us to know about. If you receive special education services, please describe that here as well. We also request that you fill out the Release of Records Form (page 6) so that we may talk with people on your support team.


9. Have you ever been dismissed or suspended from school for any reason? Yes No

If yes, please explain fully. Please include the name of the school and principal.


Essay Question
Please choose one topic from the options below and write a one-page, typed or handwritten response. Your essay should reflect your own thoughts, ideas, and writing skills. Your parents, teachers, friends, etc. should not edit your writing. Please check one of the boxes below and staple your essay to the back of this form.

Tell us about an ethical dilemma you've faced and describe its impact on you.
What book, song, movie, or piece of art is meaningful to you and why?
Describe what Community means to you. In what ways do you contribute to your community?
In your opinion, what is the greatest challenge your generation will face? What ideas do you have for dealing with the issue?


Completing Your Application
The undersigned applicant understands that final acceptance for participation in the program will be based on these areas:
1. Completion of the application.
2. Participation in an interview.
3. Ability to describe how the program works and an understanding of Program Commitments.
4. Personal desire to participate in the program.
5. Evidence that you can expect to be successful in this program. This evidence may include, though is not limited to, conversations with staff from your sending school, family members, caseworkers or special education staff (if applicable), and other references.
6. Participation in the pre-school year camping trip.

Please type your full name and today's date in the fields below to electronically sign this form.
Signature of applicant: Date:

Signature of parent / legal guardian: Date:

Deadline: Applications will be considered as they are received. Those wishing to participate in the 2011-12 school year should make effort to apply by July at the latest. Applications received after that time will be considered based on space available.

The CCLC reflects the diversity of the people of the Cobscook region and celebrates the diversity of all people.  We do not discriminate against current or prospective participants on the basis of race, color, national or ethnic origin, economic status, gender, sexual orientation, religion, marital status, age (except as indicated for age-specific programs) or disability.