A SUMMER PROGRAM FOR GIFTED AND TALENTED HIGH SCHOOL STUDENTS
Student Application
GOVERNOR’S SCHOOL 2013
STAPLE – NO PAPER CLIPS

1. BASIC INFORMATION AND DEMOGRAPHIC DATA
Academics

PAGE 1 OF 2
FORM MAY BE COPIED
Performing/Visual Arts
Name ____________________________________________________________________________________________________________
First
Middle Initial
Last
Preferred Name ______________________________________________________
Age _______
Sex _______
Race _______
Mailing Address __________________________________________________________________________________________________
Street or Box No.
Telephone ( _______ ) ____________________________
City
Zip Code
Last Four Digits of Social Security Number ______________________
Public County or City School System ________________________________________________________________________________
Public High School ______________________________________________________________________________
Grade _________
Charter or Non-Public High School County ____________________________________________________________________________
Charter or Non-Public High School ________________________________________________________________
Grade _________
2. NOMINATION AREA – Indicate only one area

Academics (Rising Seniors only; check one specific area)
___ English
___ Mathematics
___ Natural Science
___ Social Science
Notes • Students in Mathematics must have completed
Algebra II or Integrated Math III before the
2013 session begins.
• Students in Spanish and French must have completed
at least two years of study in these courses before
the 2013 session begins.
___ Spanish
___ French

Performing/Visual Arts (Check one specific area)
Notes • Instruments offered are: Flute/Piccolo, Oboe/English
Horn, Clarinet (E-Flat, B-Flat, Alto, Bass, Contralto, and
Contrabass), Saxophone (Alto, Tenor, and Baritone),
Bassoon, Trumpet, French Horn, Trombone, Euphonium,
Tuba, Percussion, Violin, Viola, Cello, Bass, and Harp.
• Piano and guitar are not offered.
___ Art (Rising Seniors only)
___ Dance (Rising Juniors or Seniors)
___ Theater (Rising Seniors only)
___ Choral Music (Rising Juniors or Seniors)
List Voice Part _______________________________
(Soprano I, II; Alto; Tenor; Bass/Baritone – List only one)
___ Instrumental Music (Rising Juniors or Seniors)
List Instrument ______________________________
3. STATEMENT OF INTENT
My signature indicates my wish to be considered as a Governor’s School nominee. I understand that I will be identified
as a Governor’s School nominee only if determined by the local nominating committee. I understand that if I am selected
by the State, and if I accept, I will attend the entire five-week program. I further understand that no exceptions will be
made for family reunions, cheerleading camps, sports activities, and the like.
____________________________________________________
Signature of Student
Date
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____________________________________________________
Signature of Parent/Guardian
Date
A SUMMER PROGRAM FOR GIFTED AND TALENTED HIGH SCHOOL STUDENTS
Student Application
GOVERNOR’S SCHOOL 2013
PAGE 2 OF 2
FORM MAY BE COPIED
4. ESSAYS
Please write two essays as directed below. Type each essay on a separate page and clearly label each page with your
name and the essay topic and, for Essay Two, the Area you have chosen. Please limit each essay to one page only,
single or double spaced.
Essay One
Identify and discuss one significant problem or issue in contemporary culture that concerns you: some of the dimensions
of this issue, why it matters to you, and what possible solutions you or others might propose to deal with it.
Essay Two
In this essay, local and state selection committee members hope to gain a clearer insight into an applicant’s interest in
the Area I field of nomination. If you know your Area I field of nomination, choose the topic for that discipline. If you do
not yet know your Area I field of nomination, choose the topic that is closest to your deepest interests.
•
Nominees in English and Performing/Visual Arts: Describe the relevance of a 20th or 21st century work of art or
literature and detail how it has influenced your thoughts and/or action.
•
Nominees in Natural Science and Social Science: Discuss an important 20th or 21st century idea in natural science
or social science and explain how it has influenced your thoughts and/or action.
•
Nominees in Mathematics: Describe your response to the following quote: “The true spirit of delight…is to be
found in mathematics as surely as in poetry.” – Bertrand Russell
•
Nominees in Spanish and French: Describe your interest in the Spanish or French language. Please include any
personal experiences specifically related to foreign language and culture and how they inspired you to explore the
Spanish or French-speaking world.
5. EXPERIENCE
Please respond to the following requests. Type responses on the Experience Form and clearly label each page with your name.
1.List school and community activities, awards, and honors you have participated in or received during the past
three years, and tell why any two are important to you.
2.List residential schools (such as Summer Ventures, NC School of Science and Math) you have attended and when.
6. RECOMMENDATIONS
Two Recommendation Forms (pages 17 and 18) must be completed by persons who know the nominee’s strengths in the
area of nomination and can address the nominee’s intellectual curiosity, love of learning, and potential to profit from the
Governor’s School experience. No parent or student should submit a recommendation.
At least one recommendation should be from a high school teacher, preferably in the area of nomination.
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