ADVANCEMENT VIA INDIVIDUAL DETERMINATION
APPLICATION FOR 2016-2017
Student’sName(PleasePrint)______________________________________________________________
Parent/GuardianName(PleasePrint)_____________________________________________________________________
Address______________________________________________________________________________
City,State,Zip_________________________________________________________________________
HomePhoneNumber_________________________CellPhoneNumber__________________________
SchoolCurrentlyAttending________________________________Grade_________________________
WhichMiddleSchoolorHighSchooldoyouplantoattendnextyear?____________________________
ParentsHighestLevelofEducation(Circleoneforeachparent)
Mother
Elementary+:56789101112
Father
Elementary+:56789101112
University/College/Tech.School:1234University/College/Tech.School:1234
Degree:MastersDoctorateDegree:MastersDoctorate
Asaparentorguardianyoumustsupportyourchildinhisorherattempttopursuethedreamofgoing
tocollegeandbeanadvocateforhisorhersuccess.Areyouwillingtoattendatleastoneinformation
meetingaboutAVIDandhelpensurethatyourchildisstudying1to2hoursafterschoolandkeepingan
organizedbinderandplanner?
YESNO
Parent/GuardianSignature__________________________________________
AsanAVIDstudentyouwillberequiredtomaintainpassinggrades,toalwaysputforthyourbesteffort,
andtobearolemodelintheschool.Thismeandisciplineshouldnotbeaproblem.Areyouwillingto
followtheseguidelines?
YESNO
StudentSignature_____________________________________________________
Parent/GuardianQuestionnaireForm
Student’sName(Print)____________________________Date_________________________________
ParentName_____________________________________Phone________________________________
Providinginformationaboutyourchild’seducationneedsiscrucial.Pleascompletethisformasapartof
theAVIDapplicationforyourstudent.
I.
1. BrieflydescribewhyyoubelievethatyourstudentandtheAVIDProgramwouldbeagoodfit.
Whatwouldyourstudentbringintermsofacademicstrengths,motivation,anddesireto
succeedtotheprogram?
2. WhatdoyoubelievetheAVIDprogramcandoforyourstudent?Whatsupportdoesyour
studentneed?
3. Asaparent,whatdoyoubelieveyourroleisinhelpingyourstudentprepareforcollegeanda
career?
II.
4. Usingascalefor1to10,rateyourstudent’sstrengths.
1=notstrongatall,10=Very,verystrong
Strength
Rating
Strength
Rating
GoodListener
PositiveAttitude
Motivatedtolearn
Cooperative/helpful
Abilitytofollowdirections
LeadershipQualities
TakingResponsibility
Cooperativelearning
Workswellalone
Creative
Artistic
Musical
Goodsenseofhumor
Intelligent/AcademicallyCapable
AbilityorinterestinMath
AbilityorinterestinLanguageArts
AbilityorInterestinScience
AbilityofinterestinHistory/Social
Students
Otherstrengthsnotmentioned?Listbelow
andrank:
III.
5. Arethereanyspecialcircumstances(personalorfamily-related)thatmaybebarrierstoyour
child’sacademicsuccessorabilitytoattendcollege(withoutadditionalsupports)?