Application Packet for the Theodore Judah
Academy for Advanced Learning
PLEASE RETURN COMPLETED PACKET ELECTRONICALLY AS A PDF FILE BY FEBRUARY 1, 2017.
PLEASE NOTE: INCOMPLETE PACKETS WILL NOT BE ACCEPTED.
The Academy is designed for children for whom the pace and the content of the curriculum at their
grade level do not match their intellectual needs. Its purpose is to provide challenge in a supportive
environment, to foster a passion for learning, and to develop rigorous habits of mind. This program is
not for every child. Successful students must have high academic performance, self-motivation,
curiosity, and an ability to work independently. Please consider carefully your child’s study habits,
behavioral characteristics, and academic ability before you apply.
FOR STUDENTS APPLYING FOR GRADES 1:
Criteria for selecting students entering the first grade include evidence of high academic achievement,
reading ability, teacher feedback, parent nomination form, and a score from an ability test. A test will be
administered by the Folsom Cordova GATE office at no cost to the applicant. Results of testing will be
used to help better understand a child’s learning profile and will be used in conjunction with all other
information. There is not a “passing score” for this test. Please note: These tests are very different
from CAASPP tests. Parents are not to prepare or coach students on how to take this test in
advance. Results are only valid when given to a student who has not practiced prior to the test. We
consider prior preparation as cheating on this test.
Entrance into the program is through:
• Parent Nomination Form
• Teacher Feedback Form. Please give to your student’s classroom teacher and ask them to return
it directly to GATE Department. If you reside or are currently enrolled outside of the
Folsom Cordova Unified attendance area, Teacher Feedback Form is not required.
• High Academic Achievement as demonstrated through:
(a) Classroom grades
(b) Benchmark exams/I-Ready
(c)
Evidence of advanced achievement
- Students whose first language is not English and who score Proficient (Level 4) on the ELA portion
(e)
(f)
will still be considered for admission.
Results from an ability test. Registration for testing is included in this packet.
Previously administered IQ test results (NOT required for admission)
Completed applications are due February 1, 2017. Applications received after February 1, 2017 will be
reviewed after all other applications have been considered. Currently there are a limited number of spaces
available in first grade at each site.
THEODORE JUDAH
ELEMENTARY SCHOOL
101 Dean Way
Folsom, California 95630
(916) 983-4469
THE ACADEMY FOR
ADVANCED LEARNING
APPLICATION FOR ENROLLMENT
APPLYING FOR GRADE (next year’s grade):
1
2
** Online Application Packet due February 1, 2017**
Student Name: (Provide Legal Name from Birth Certificate)
Last Name:
First Name:
Date of Birth:
MI:
Current 2016 - 2017 Grade:
Please Check:
Female
Parent/Guardian/Legal Caregiver Information:
Last Name:
First Name:
Street Address:
City:
Home Telephone:
Male
MI:
Zip:
Cell Phone:
Work Telephone:
Email Address:
School Information:
Name of Current School: _________________________________ Name School of Residence: _________________________________
PROGRAM INFORMATION
• The Academy is designed for children for whom the pace and the content of the curriculum at their grade level do not match their
intellectual needs. Its purpose is to provide challenge in a supportive environment, to foster a passion for learning, and to develop rigorous
habits of mind.
• This program is not for every child. Successful students will have high academic performance, self-motivation, curiosity, and a
willingness to be challenged.
• The Academy extends and enriches instruction in grade level standards by adding depth and complexity through a variety of learning
opportunities and alternate curriculum. If parents are primarily looking for an acceleration program, the Academy is not a good match.
• Students spend their academic day in Academy classrooms and have opportunities to make friends with other students at the school
during lunch, recess, assemblies/school-wide activities, and after-school programs.
• It is not our goal to have the students do more homework; we want homework to be developmentally appropriate and we encourage a
balance between school-based learning and extra-curricular activities.
• Students will have access to the same grade level core curriculum found in all FCUSD schools with emphasis on enrichment and
extension based on students’ abilities and interests. Additional materials will be provided such as Jr. Great Books, FOSS Science, M2 and
M3 Math, Being a Writer, and accelerated or enriched math resources to ensure greater challenge and experiential learning.
• All applicants who are not GATE identified by FCUSD will be given an ability test as part of the application process.
• Please visit www.fcusd.org/TheAcademy for updates and more information.
Parent or Legal Guardian Signature:
Date:
Parent Nomination for the Academy for Advanced Learning
Today’s date:
Student Name:
Grade Applying For (next year’s grade):
Parent Name:
Email Address:
Current School
Number of Students in Current Classroom
Birth Date:
Phone Number:
Student’s First Language:
Current Teacher:
Please submit electronically as a PDF file at [email protected].
A copy of the most recent report card and a report card with teacher comments.
Please complete the following questionnaire using examples to describe your child. Be as specific as
possible. It is not expected that students will demonstrate all of these characteristics nor is it
necessary that they do so. Please use the scale to indicate how much you think each item describes
your child. If you would like to share something about your child you think is important but is not on
this questionnaire, feel free to attach an additional page. You may complete this form in your native or
most proficient language.
1.
Shows curiosity and desire to learn.
Very Much
Yes
Somewhat
Not Much
Don’t Know
Not Much
Don’t Know
Personal example:
2.
Has a special interest or passion (if so, what?).
Very Much
Yes
Somewhat
Personal example:
3.
Takes responsibility for completing assignments and homework.
Very Much
Yes
Somewhat
Not Much
Don’t Know
Personal example:
4.
Performs regularly at a high academic level.
Very Much
Yes
Somewhat
Not Much
Don’t Know
Yes
Somewhat
Not Much
Don’t Know
Enjoys jokes and/or has a sense of humor.
Very Much
Yes
Somewhat
Not Much
Don’t Know
Personal example:
5.
Works independently.
Very Much
Personal example:
6.
Personal example:
7.
Willing to work hard/persevere.
Very Much
Yes
Somewhat
Not Much
Enjoys sports or the arts (if so, what?).
Very Much
Yes
Somewhat
Not Much
Don’t Know
Somewhat
Not Much
Don’t Know
Somewhat
Not Much
Don’t Know
✔
Don’t Know
Personal example:
8.
Personal example:
9.
Enjoys reading and reads well.
Very Much
Yes
Personal example:
10. Excels at mathematics.
Very Much
Personal example:
Yes
11. Classroom behavior does not interfere with learning.
Very Much
Yes
Somewhat
Not Much
Don’t Know
Not Much
Don’t Know
Personal example:
12. Is critical of self or work products (perfectionist).
Very Much
Yes
Somewhat
Personal example:
13. Is self-motivated.
Very Much
Yes
Somewhat
Not Much
✔
Don’t Know
Personal example:
14. If your child has received special recognition, awards or honors please describe below:
TESTING REGISTRATION FOR GATEWAY ACADEMY APPLICANTS
[FCUSD GATE-IDENTIFIED STUDENTS ARE EXEMPT FROM TESTING: DO NOT REGISTER IF STUDENT IS GATEIDENTIFIED]
Applicant Name:
Contact Name:
Phone Number:
Please register for ONE of the following times. Make a note on your calendar and plan to arrive 15 minutes
prior to your testing time. You will not receive a confirmation or a reminder of your testing date and time.
If for any reason we cannot accommodate your selection we will contact you directly with an alternate choice.
Therefore, we will only contact you if we need to reschedule. If you do not hear from us that means you are
scheduled for the date and time you selected.
Please note: These tests are very different from SAT tests. Parents are not to prepare or coach students on
how to take this test in advance. Results are only valid when given to a student who has not practiced prior
to the test. We consider prior preparation as “cheating” on this test. There is no set cut-score for admission
to the program.
TESTING DATE AND LOCATION:
Theodore Judah Elementary School
101 Dean Way, Folsom, CA 95630
Thursday, February 9, 2017
 3:30 P.M.
 5:30 P.M.
Thursday, February 16, 2017
 3:30 P.M.
 5:30 P.M.
Make a note on your calendar and plan to arrive 15 minutes prior to your testing time to sign a
permission to test form.
Please submit electronically as PDF files the following three items to [email protected].
Very important: Include “Academy Application Packet” in the email subject line.
Completed Application Packet
A copy of the most recent report card and a report card with teacher comments; and
Teacher Feedback From