To be fully aware of all program expectations, be certain you and your parent/guardian read all documents before signing and submitting this application. Please type and print this completed application


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NameTo be fully aware of all program expectations, be certain you and your parent/guardian read all documents before signing and submitting this application. Please type and print this completed application
A typeDocumentation
Marriotts Ridge High School

Gifted and Talented Intern-Mentor Program

Application
To be fully aware of all program expectations, be certain you and your parent/guardian read all documents before signing and submitting this application. Please type and print this completed application. No handwritten applications please.
APPLICATION DEADLINE: JANUARY 13, 2017
You may give it to Mr. Eckert or place it in his mailbox in the front office.

Step One: Application Information

Student Name: _____________________________ Grade Level for current year ______

Address: _______________________________________________________________

Home Phone: ( ) ______________________ Cell Phone: ( ) ________________ Parent Cell Phone: ( ) ________________

Student email____________________________________________________________

Parent email _____________________________________________________________

Credits Requested: One Credit ________ Two Credits _______

Transportation: I will drive myself: ____ Driver’s License Number: ______________

Explain other arrangements:

________________________________________________________________________

Step Two: Field of Interest

Remember that participation in the Intern-Mentor Program is influenced by the availability of mentors. The number of qualified and willing professional mentors in each field of interest can vary greatly. Identifying potential mentors may facilitate your placement. Indicate your field of interest and be as specific as possible (for example, Education – Elementary).

*Do not contact the Johns Hopkins Applied Physics Laboratory, Howard County General Hospital, Johns Hopkins Hospital, or the Howard County Animal Shelter directly. See your G/T Teacher.
Field of Interest: __________________________________________________________

Alternative if no mentor can be secured in your first choice area: ___________________
Note: Students are encouraged to identify potential mentors. Research teachers will then contact them.
1. Name: __________________________ Phone: ______________________________

Organization/Title: ______________________________________________________

Email Address:_________________________________________________________
2. Name: __________________________ Phone: ______________________________

Organization/Title: ______________________________________________________

Email Address:_________________________________________________________

How did you locate the above leads? __________________________________________
Step Three: Questions
Please type your answers on a separate sheet of paper and attach them to the application.

These answers may be given to your potential mentor, so think and respond carefully to each one.


  1. Why are you interested in this field?




  1. What skills and knowledge do you possess that will provide a background for an internship in your area of interest (for example, computer applications and/or programming skills, communication skills; related course work and experience; private instruction; training; volunteer experience; previous internships)?




  1. It is important to be realistic when considering your expectations of a mentor.



    1. What experiences do you expect your mentor to provide?




    1. What do you expect to do when you are with your mentor?




  1. What specific strengths do you have to offer a mentor?




  1. Geographic limits may restrict the availability of a mentor. List any areas to which you cannot drive.


Step Four: Supporting Documents
Attach the following documents to this application

  • two recommendations (at least one from a teacher)

  • a resume (see sample below)


*Mr. Eckert will request your transcript, most recent report card and attendance report if necessary and attach it to your application. Do not go to Student Services to do this.


Step Five: Checklist
In advance of the application deadline, be certain the following application components are in order:

____ application form with signature of parent/guardian

____ answers to application questions (a resume is helpful but not required)

____ resume

____ This Year’s Student Schedule sheet
____ two recommendations (at least one from a teacher)

Step Six: Interviews
Interviews will be held during breaks and the lunch shifts in February. This interview will allow us to discuss possibilities regarding the course. Please arrive with an idea of the type of place that you would like to intern at or contact information for any leads that you may have. The Google doc link to do this will be shared with you in the near future. Do not miss class to come to an interview. Only sign-up during your lunch time or breaks. Interviews are 15 minutes long so you can eat during the first 15 minutes and then come for your interview or you can eat after your interview. There will be a few after-school slots. Don’t miss your interview time. You will receive no reminder notices.
Step Seven: Signatures
Timely submission of this application is the responsibility of each applicant. Students submitting incomplete applications will not be considered for the program. Final acceptance into the Gifted and Talented Intern/Mentor Program depends on a successful interview with the Gifted and Talented resource teacher and successful location of an appropriate mentor. Signing below indicates that you have read the information above and the contract and that you are familiar with the expectations of this program.
Student Signature: __________________________ Date: __________________
Parent Signature: ___________________________ Date: __________________

Submit all application materials to Mr. Eckert by JANUARY 13, 2017.
Please return this completed form to Mr. Eckert by JANUARY 13, 2017.

Howard County Public School System

GIFTED AND TALENTED INTERN MENTOR RESEARCH COURSE

TEACHER RECCOMENDATION
Student: ___________________ Area(s) of Interest: __________________________
Students accepted into the Intern Mentor course work on an original research project or creative performance involving college-level research. Your input is being sought in trying to assess the likelihood of the above-mentioned student’s success in a long-term, independent, college-level research course.
Please supply information about the above student with regard to the following areas:
Ability to carry out in-depth independent work: poor____average___excellent___don’t know

Interpersonal skills:________ poor average excellent don’t know

Initiative:_________________________________poor average excellent don’t know

Time-Management: poor average excellent don’t know

Maturity and task commitment: poor average excellent don’t know

Enthusiasm and sincerity: poor average excellent don’t know

Integrity and demonstrated reliability: poor average excellent don’t know


Overall: ____Highly recommend ____Recommend ____Recommend with reservations

Additional Comments:
_________________________________________________________________________

_________________________________________________________________________
_________________________________________________________________________

Evaluator’s signature: _______________________ Date: ___________________
Subject(s) Taught: _____________________________________________________
How long and what capacity have you known this student: _____________________

Please return this completed form to Mr. Eckert by JANUARY 13, 2017.
Howard County Public School System

GIFTED AND TALENTED INTERN MENTOR RESEARCH COURSE

TEACHER RECCOMENDATION

Student: ___________________ Area(s) of Interest: __________________________
Students accepted into the Intern Mentor course work on an original research project or creative performance involving college-level research. Your input is being sought in trying to assess the likelihood of the above-mentioned student’s success in a long-term, independent, college-level research course.
Please supply information about the above student with regard to the following areas:
Ability to carry out in-depth independent work: poor____average___excellent___don’t know

Interpersonal skills:________ poor average excellent don’t know

Initiative:_________________________________poor average excellent don’t know

Time-Management: poor average excellent don’t know

Maturity and task commitment: poor average excellent don’t know

Enthusiasm and sincerity: poor average excellent don’t know

Integrity and demonstrated reliability: poor average excellent don’t know


Overall: ____Highly recommend ____Recommend ____Recommend with reservations

Additional Comments:
_________________________________________________________________________

_________________________________________________________________________
_________________________________________________________________________

Evaluator’s signature: _______________________ Date: ___________________
Subject(s) Taught: _____________________________________________________
How long and what capacity have you known this student: _____________________
Please return this completed form to Mr. Eckert by JANUARY 13, 2017.
This Year’s Schedule Sheet
Student Name ___________________________________ Grade Level this year ______
Student Email Address: _________________________________
Parent Email Address : __________________________________

Teacher Rm # (if possible) Subject
Pd.1 ______________________ _________ ________________________

Pd.2 ______________________ _________ ________________________

Pd.3 ______________________ _________ ________________________

Pd.4A ______________________ _________ ________________________

Pd.4B ______________________ _________ ________________________

Pd.5 ______________________ _________ ________________________

Pd.6 ______________________ _________ ________________________

SAMPLE RESUME

Sue Brown

1234 Oak Road

sue_brown@hotmail.com

410-235-7895
Objective: To pursue a teaching career and further advance in the field of educational psychology or administration/ supervision.

 

Education 2004 – present    Marriotts Ridge High School    Marriottsville, MD

         2004 – present: 3.8 un-weighted GPA

         Honor Roll Student

         Honors, Gifted and Talented, and Advanced Placement classes

         National Honor Society member

         Spanish National Honor Society member

           

Extracurricular Activities

         2006 – present: Junior Dance Company

         2006 – present: Human Rights Awareness Club

         2006 – present: Brothers and Sisters in Christ (BASIC)

         2004 – present: Cheerleading: Junior Varsity [1yr.] and Varsity[2yrs.]

 

Awards Received      

         2006: Most Improved in Cheerleading

         2005: Outstanding Achievement in Biology and Health

         2004 – present: Scholar Athlete Award for Cheerleading

         2004-2006: student of the month (5 times)

         2004: Honor Roll

 

Work Experience

         2006 – present: Assistant Instructor at Top Flight Gymnastics

         2006: Tutoring a 1st grade ESOL student

         Winter 2004: Assistant coach for Upwards Cheerleading

 

Volunteer Experience

         2006 – 2007: Teaching preschoolers Spanish at Bet Yeladim

         2006 – 2007: Project Head Start

         Fall 2006: ESOL Adult Program at St. John’s Lane Elementary school

         Summer 2006: ESOL Office at the Board of Education

Interests and Activities       

         Future plans: attend a 4 year university, major in Educational Psychology

  • Interests/ Activities: photography, dance, cheerleading, and traveling

References

         Available upon request.

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