Pulaski Youth Leadership

Class of 2009 – 2010

Application

Important: Keep a copy for your records.

School__________________________________________________________

Name___________________________________________________________

Address_________________________________________________________

Emergency Contact and Phone _____________________________________

School Year:

_____ 8    ______9   _____ 10   _____11                DUKE - TIP Year Taken: ______                                 

ACT - Year Taken: ______ 

2009- 2010 Cumulative Grade Point Average ________________

Current Course Enrollment:

List all completed courses grades 7, 8, 9 & 10:

Extracurricular Activities and Community Service: (Grades 7, 8, 9 & 10) List the extracurricular activities in which you have been involved and provide a description of your contribution to that activity.  For example, what activities did you initiate and/or what responsibilities did you assume and what was the importance of your role? This may include school activities (National Honor Society, Band, etc.) and community activities (4-H, Girl Scouts, etc.).  Do not abbreviate activity names.  Be sure to note the length of time you have been involved.  For example, 7^th and 8^th, 8^{th, 9th} & 10^th or only 8^th; etc.

Service Examples: 

Adopt-A-Highway                                        Habitat for Humanity

Volunteer at Soup Kitchen                          Fundraising for Cancer Society

Page for Kentucky House or Senate          Special Olympics

Internships                                                  Sunday School Teacher

Food Drive                                                  Athletic Coach/Referee

Walk-a-Thon                                               Salvation Army

Toys for Tots                                               Mission Work

Work at Homeless Shelters                        Singing Christmas Carols

Honors: (Grades 7, 8, 9 & 10) List honors and awards you have received in the past few years (grades 7, 8, 9, & 10).  Do not list those received prior to 7^th grade unless of major significance (e.g. TIP Program, national or statewide award, etc.).  Please do not list involvement in organizations and clubs unless you have been elected to an office or selected for a specific honor. 

Code: I- International, N-National, S-State, R-Regional, D-District, L-Local, or School.  Refer to Attachment #2 for completing this section.

Honors/Awards Examples:

Governor’s Cup Competition                                   Quick Recall Team

Most Improved on Athletic Team                             TIP Program

100% Award on Athletic Team                                Honor Roll

Page to Senator or Representative                         Office in Student Council

Ranking Portfolio (Proficient or Distinguished)        Class Officer

Published Literature                                                 Club or Organization Officer

All State Piano                                                         Science or Engineering Expo

All State Choir                                                         Leadership Service Awards

Captain of Athletic Teams                                       Scouting Awards

Pulaski Youth Leadership

2009-2010

Selection Rating Rubric

A. ____________        (60 Points)            Academic Achievement

            1.   _________   (0-10 points)         Grade Point Average

            2.   _________   (0- 30 points)        Difficulty of Current Course Work*

            3.  __________   (0- 20 points)      Difficulty of Past Course Work

B. _______________    (40 Points)         Student Profile

            1.  __________   (0-25 points)       Extracurricular Activities and

                                                                        Community Service

2.  __________   (0-15 points)       Honors/***Attendance

If you were a member of the 2007–2008 & 2008-2009 Pulaski Youth Leadership Class, you may not apply for the 2009 – 2010 Pulaski Youth Leadership Class.

*Attachment #1 for Difficulty of Course Load

** Attachment #2 for Guidelines to Complete Honors Section

***Attendance will be supplied by school Gifted Specialist and guidance staff.

Parent/Guardian Signature                                     

Emergency Contact

Name: ________________________________________________________________

Address:

Phone at work or via cell:

THIS APPLICATION MAY BE FOUND ON-LINE AT PULASKI.NET OR AT THE RESPECTIVE MIDDLE SCHOOL AND HIGH SCHOOL WEBSITES.  High School APPLICANTS need to fill out this application on line and make a hard copy for the guidance office at the high schools. Middle school APPLICANTS need to submit their copy to Mrs. Bales at SMS or Mr. Dodson at NMS.  Deadline for submission: 4:00 PM

September 4, 2009.

Attachment #1

Ranking for Difficulty of Course Load

1.       This student has taken only the required curriculum, in lower level classes, and has not selected any academic subjects as electives.

2.       This student has taken at least one honors or advanced class or at least one class in the higher level if honors or advanced not available and has not selected academic subjects as electives.

3.      This student has taken at least two honors or advanced courses or two coursed in the higher level of courses if honors or advanced not available.  

4.      This student must have taken three or more honors or advanced courses in three or more course in the higher level courses if honors and advanced not available.  Student may have taken one year of engineering or foreign language and selelcte4d academic courses as electives.

5.      This student has taken honors or advanced courses in most/all subjects offered or highest level of courses offered in school without honors or advanced courses.  Student may have taken two years of engineering or foreign language and chosen academic courses as electives. 

Difficulty of Course Load

____ 1

____ 2

____ 3

____ 4

____ 5

Attachment #2

Guidelines to complete the Honors Section

·        International – Recognition in a program that included international competition; e.g., International Science Fair, International community problem solving.

·        National – Recognition in a program that included national competition with the selection being made at the national and not lower levels; e.g., TIP (if  selected to participate in the DUKE and Western Kentucky University Programs, not just to take the exam);  top scores on foreign language, mathematics, or other subject area exams; e.g. national Knowledge Master, Beta Club; publications in literary or other magazines; art or science fairs; American Junior Miss or other such pageants; debate tournaments; etc.

·        State – Recognition at the state level: e.g., winner in state science fair, Governor’s Cup or Sweet Academic Showcase Competitions; selected for All-State band, chorus or athletic teams; placed in state athletic competitions (track, swim meets, etc.); designated as distinguished on CATS exams or portfolio assessments (8^th grade level); recognized for TIP program (7^th/8^th grade level); publications in statewide literary or other magazines; etc. (Academic team achievements, e.g., Quick Recall or Future Problem-Solving, would also be included here.)

·        Regional – Recognition in multi-school or multi-community program; e.g., regional science or art fairs, quick recall contests, regional level of Governor’s Cup or Sweet Sixteen Academic Showcase competitions, all-tournament athletic teams, etc.  (Academic team achievements, e.g., Quick Recall or Future Problem-Solving, would also be included here.)

·        District – Recognition in school district competitions; e.g. math leagues, academic competitions, art fairs, athletic or academic awards, etc. (Academic team achievements, e.g., Quick Recall or Future Problem-Solving, would also be included here.)

·        Local – Recognition through selection into organizations such as National Honor Society, Beta Club; participation in the Governor’s Cup, Quick Recall, Future Problem-Solving, etc.; placement in school contests; e.g., writing program, art and science fairs, etc.; or academic awards in subject areas; e.g., designation as Outstanding English or Math 9 or other subject area) Student recognition in “Who’s Who Among American High School Students.”