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Galileo School of Math and Science District 11 1600 N. Union Blvd. Colorado Springs, CO 80909 719-328-2200 Scholar Information Last Name: _______________________________First: _________________________________ Middle: __________________________Name Goes by:_________________________________ Street Address: __________________________________________Apt#:___________________ City: ________________________________________ State: _______ Zip:_________________ DOB:____/___/_____

Male: ___ Female: ___ Grade Level for the 2009-10 Year: _______

School now attending: _____________________________Home District: __________________ City: _________________________________________State: _______ Zip:__________________ Parent/Guardian(s) Information Mother/Guardian’s name: __________________________Day phone: (___)_______________ Street Address(if different):_____________________________________ Apt#:_______________ City: ________________________________________ State: _______ Zip:__________________ Home phone: (____)_______________________Cell/Pager: (____)________________________ E-mail Address: _________________________________________________________________ Military Status:

Branch______________ Active Duty _____

Retired_______ None______

Father/Guardian’s name: ___________________________Day phone: (_ _)_______________ Street Address(if different):_____________________________________ Apt#:_______________ City: _______________________________________ State: _______ Zip:__________________ Home phone: (____)______________________ Cell/Pager: (____)________________________ 1


E-mail Address: ________________________________________________________________ Military Status:

Branch______________ Active Duty _____

Retired_______ None_______

Exceptional Student Status if applicable IEP (Individual Educational Plan)________ 504__________ Gifted and Talented__________ ILP (Individual Literacy Plan) ________ I understand that participation in the Galileo School of Math and Science is dependent upon a successful application process. Both applicant and Parent/Guardian(s) will need to commit to an application interview. I understand that completing the application process does not necessarily guarantee acceptance into the school. Transportation for scholars outside of the school boundaries is the responsibility of the Parent/Guardian. Both applicant and Parent/Guardian understand that long term or excessive absences are strongly discouraged. I understand and agree to abide by the Galileo School of Math and Science Guidelines. __________________________________________ Scholar Signature

_________________________ Date

__________________________________________ Parent/Guardian Signature

_________________________ Date

I agree to follow the educational expectations contract attached to this application. ____________________________ Scholar’s Signature

____________________________ Parent /Guardian’s Signature

____________________________ Principal’s/Designee’s Signature

____________________________ Date

____________________________ Date

____________________________ Date

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Educational Expectations Contract Scholars, Parent/Guardian(s) and staff all share the responsibility for scholar learning. By reading and signing this Contract everyone contributes to the scholar’s success. High Expectations for Student Achievement As the Scholar I will…

As the Parent/Guardian I will…

• Come to class prepared to learn: -Bring appropriate learning tools -Bring assignments to school as scheduled -Attend school daily and on-time

• Strive to achieve the learning targets for each of my classes using the prescribed expectations. • Actively seek support when I need it. • Participate in Extended Learning Opportunities (i.e. support sessions, research projects, & other learning activities). • Participate in Saturday Learning Opportunities (i.e. after school tutoring, research projects, & club activities). • Work hard to do my best. • Attend mandatory meetings.

• Make sure my child attends school prepared to learn. • Set high expectations for my child’s performance. • Review the learning targets and prescribed expectations for each of my child’s classes. • Keep track of my child’s progress through Parent Connect. • Monitor completion of scheduled assignments, and projects. • Be an advocate for my child when he/she needs support. • Encourage participation of Extended Learning Opportunities (i.e. support sessions, research projects, & other learning activities). • Attend mandatory meetings.

As the Galileo School of Math and Science staff will… • Provide a welcoming environment • Have high expectation for ALL scholars. • Clearly communicate grade level expectations and prescribed expectations. • Clearly communicate daily learning targets. • Provide appropriate instruction based on Colorado Standards and District 11 curriculum. • Differentiate instruction based on diverse learning styles and interests. • Keep up with current research and best practices. • Hold students responsible for work completion and quality. • Inform Parent/Guardian(s) of ways to support their child’s progress.

Safe and Effective Learning Environment As the Scholar I will…

As the Parent/Guardian I will…

• Abide by the Rights and Responsibilities Handbook of District 11. • Respect the rights and property of others. • Be respectful, courteous and cooperative towards fellow scholars, families, community members and school personnel. • Follow classroom and school rules. • Respect my learning environment. • Demonstrate appropriate behavior.

• Support my child to abide by the Rights and Responsibilities Handbook of District 11. • Respect the rights and property of others. • Be respectful towards scholars, families, community members, and staff. • Use discretion when contacting my scholar during school hours. • Provide my child with guidance in demonstrating appropriate behavior

As the Galileo School of Math and Science staff will… • Enforce and model the Rights and Responsibilities Handbook of District 11. • Enforce and follow rules concerning safety and respect. • Enforce the rights and protect the property of all students and staff. • Be respectful towards scholars, Parent/Guardian(s), community members, and fellow educators. • Enforce, educate, and model classroom and school rules. • Support and model appropriate behavior.

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Dressing for Success As the Scholar I will… • Abide by the student dress guidelines in the Student Rights and Responsibilities Handbook (i.e. business casual).

As the Parent/Guardian I will… • Make sure that my child abides by the dress guidelines in the Student Rights and Responsibilities Handbook. • Provide my child with guidance in choosing attire that meets school and School District 11 guidelines.

As the Galileo School of Math and Science staff will… • Educate scholars and Parent/Guardian(s) on the dress guidelines of the school and School District 11. • Enforce the dress guidelines of the school and School District 11. • Support our colleagues with enforcement of the dress guidelines of the school and School District 11. • Model professional and appropriate attire.

Effective Communication As the Scholar I will… • Actively engage in your learning environment. • Talk with my family about what is going on at school. • Engage in communication with your school community that supports a positive learning environment. • Use a kind, respectful tone and language when speaking to others. • Respect other’s individuality.

As the Parent/Guardian I will…

As the Galileo School of Math and Science staff will…

• Use school information sources to keep up with school issues and activities (i.e. Parent Connect, School Newsletters). • Discuss with my child what is going on at school. • Participate in Parent/Guardian involvement opportunities, and school led seminars. • Use a kind, respectful tone and language when speaking to others. • Respect other’s individuality

• Inform Parent/Guardians of scholar’s progress in an effective manner. • Provide scholars with feedback in a timely manner. • Respond to Parent/Guardian’s and scholar’s questions and concerns in a timely manner. • Support meaningful involvement and partnership opportunities for Parent/Guardian(s) and scholars. • Use a kind, respectful tone and language when speaking to others. • Respect other’s individuality

PUBLIC NOTICE School District 11 is committed to a policy of nondiscrimination in relation to race, creed, color, sex (gender), ancestry, sexual orientation, religion, national origin, age and/or disability. Racial and/or sexual harassment of students will not be tolerated and must be brought to the immediate attention of the school principal or D-11 nondiscrimination compliance/grievance coordinator.

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