Application for Eleanor Roosevelt High School

Puente Program
The mission of the Puente Program is to increase the number of educationally disadvantaged
students who enroll in four-year colleges and universities, earn degrees, and return to the community
as leaders and mentors for future generations. In Puente, students will have a specialized Puente
English class that emphasizes multicultural literature during their 9 th & 10th years, participate in the
Puente Club all 4-years of high school, have the same counselor all 4-years of high school, participate
in college and cultural fieldtrips, and receive opportunities to hear from professionals within our
community. Students must commit to be involved in their classes and in the Puente Program/Club.
Other requirements for applicants are satisfactory citizenship, good attendance and a 2.0 minimum
g.p.a.
Please Print:
Student
name:________________________________________________________Student
ID:______________________________________________
Current
Grade
Level:
__________________Current
School
Attending:____________________________________________________________
Home
Address:______________________________________________________________________________________________
____________________
Home
Phone:___________________________________________
Work
Phone:__________________________________________________________
Parent/Guardians
Email
Address:________________________________________
Cell
Phone:_______________________________________
Please answer all questions in the space provided.
1. How would you describe yourself? (Check all that apply)
American Indian or Alaska Native
Black/African American
White/Caucasian American

Asian/Pacific Islander
Hispanic/Chicano/Latino
Other (please

2. Are
you
currently enrolled in the Free and Reduced Lunch Program? Yes______ No______
3. Besides English, do you speak another language? Yes______ No_______ If yes, what language?
______________________
4. Parental Status (Circle One):
Married
Divorced
Separated
Single
I do not live with my parents
5. What is their highest level of education?
Mother/Guardian (check only one)
Did not graduate high school
High School Graduate
Some College
4-Year college Graduate or Higher
Other (please

Father/Guardian (check only one)

Did not graduate high school
High School Graduate
Some College
4-Year college Graduate or Higher
Other (please

Yes
No
6. Will you be the first in your family to attend college?

Yes
No
7. Will you be the first in your family to graduate from a four-year university?

Yes
No
8. Are you willing to challenge yourself in Honor and Advanced Placement
Yes
No
classes?
9. Are you willing to go to tutoring before and after school if necessary?
Yes
No
9. Are you willing to take summer classes to get ahead or improve?
Yes
No
10. Do you take initiative and personal responsibility in your classes?
Yes
No
12. Do you have difficulty completing all homework on a regular basis? If yes,
explain why.
______________________________________________________________________________________________________
_________

______________________________________________________________________________________________________
____________________________________13
What
are
your
career
goals?
______________________________________________________________________________________________________
14.What
is
your
favorite
subject
and
why?
_________________________________________________________________________________________
______________________________________________________________________________________________________
____________________________________15.
Who
is
your
favorite
Teacher
and
why?
________________________________________________________________________________________
______________________________________________________________________________________________________
____________________________________16. List all community or school activities youve been involved in
any leadership roles you have played within these groups. (Examples: volunteer experiences, sports,
clubs, church, hobbies and interests)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
________________________________________________________________________
17. Do you want to go to college? If so, explain why?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
________________________________________________________________________
Student Writing Sample
In the space below, explain why you believe you are a good candidate for the Puente Program?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
____________
Please check the number of school days you have missed or been tardy in the last four months.

0-2 (Excellent)

2-4 (Okay)

5 or more (Needs Improvement)

Please check the number of detentions/referrals for behavior you have received in the last year.

0-2 (Excellent)

2-4 (Okay)

5 or more (Needs Improvement)

Students: Please give the application to your teachers so that they can complete the section below.
Faculty: Please write the letter grade that the student earned in the last grading period.
Subject
Math
Languag
e
Arts
History
Science
P.E.
Elective:

Grade

Citizenship
Good
Poor
Good
Poor
Good
Poor
Good
Poor
Good
Poor
Good
Poor

Comments

Teacher Signature

Fair
Fair
Fair
Fair
Fair
Fair

I (student) would like you to please consider my application for the Puente Program.
know I must also complete the attached student agreement for consideration.
Student Signature:_____________________________________

Date: __________________________________

I (parent/guardian) support my students application to the Puente Program and complete

the attached parent/guardian agree and consent form. If my student is considered for the
Puente Program, I agree to attend an initial Puente Parent night in the Spring (you will be
contacted if considered) and conduct an in person/phone interview as part of the entire
application process. I understand that completing the application process does not
guarantee acceptance into the Puente Program.
Parent/Guardian
Date:_____________________________________

Signature:___________________________________

Yo estoy de acuerdo con la aplicacin de mi estudiante en el Programa Puente y de

completar la forma de consentimiento que se acompaa. Puedo participar en una
entrevista en persona o por telfono como parte del proceso de aplicacin. Entiendo que
el completar la aplicacin no garantiza que mi estudiante ser elegido para el Programa
Puente. Si soy informado/informada que mi estudiante ha sido elegido para el Programa
Puente, estoy de acuerdo en asistir a la reunin inicial nocturna de los padres a
efectuarse la prxima Primavera.
Firma del Padres/Tutor: ________________________________

Fecha: ___________________________

Submit your completed application ASAP.

Contact
Mrs.
Castaon,
ERHS
Puente
Counselor
by
email
at
hilda.jaureguicastan@cnusd.k12.ca.us or by phone at (951) 738-2100 with questions.
Please visit Puente.com for more information on the Puente Program.
High School Puente Project (Program) University of California
Parent Consent
I authorize my child to participate in the Puente Project. I give permission to the Puente Project to ask
my child to complete questionnaires and to participate in interviews regarding his or her experiences
in the Puente Project at his/her school. I understand that the information provided by my child will
not affect in any way his or her academic schoolwork or grades.
I also give permission to Puente Project University of California staff to collect information about my
childs academic record at this or her school as well as at previous schools that my child may have
attend or schools that my child may attend in the future.
I understand that in no case will my child be identified individually by name and that all information
will be strictly anonymous and confidential except for purposes of college and university recruitment
or to acknowledge the special accomplishments of my child.
Puente has my permission to release my childs name and address to Colleges and
Universities for the purpose of informing him or her about admissions, special Projects,
financial aid or other non-commercial purposes. Puente has my permission to release my
childs name and address to non-commercial organizations or persons who want to inform
him or her about scholarships, grants, or awards.
Students Name:____________________________________
Todays Date:_______________

High School: Eleanor Roosevelt High

Parent/Guardian
Name:______________________________
Signature:___________________________________________
Puente High School Project (Program)
Parent/Guardian and Student Agreement

Parent/Guardian

My son/daughter and I want to participate in the Puente High School Project (Program) at Eleanor
Roosevelt High School. We understand that the Puente Projects goal is to prepare students for
college and university eligibility. We agree to participate in the Project for the duration of 4 years and
Parent
Attend parent meetings related to the Puente
Project
Support and assist my student in his/her
academic and career goals, and full participation
of the Puente Project
Monitor all of my students class assignment and
contact teachers when necessary
Have your student complete academic progress
reports (preferably weekly) in an effort to
monitor your students academic progress and
contact teacher when necessary
Provide support to the Puente counselor,
teacher, and mentor to assist my son or
daughter
Provide in Puente parent/community events
to fulfill the terms outlined below.

Student
Work with my counselor to prepare for admission
into a four-year college or university
Attend all of my classes on a daily basis
Enroll in college preparation, A-G courses
Maintain above average grades (C or better)
with and intent of obtaining As & Bs
Attend any available tutoring when needed
Submit signed academic progress reports to my
parents (preferably weekly)
Participate in Community Leadership/Mentor
Activities
Attend college fieldtrips and cultural activities
Participate in extracurricular activities in school
and/or the community
Participate in Puente Club activities as stipulated

We have read the Puente Parent/Guardian Agreement and agree to work to the best of our
ability to meet the terms as stated.
We understand that this agreement will be
periodically reviewed by the Puente counselor to determine academic progress and
student participation. Based on student performance and participation, a Puente student
can be removed from the Program after at the Puente Counselor/Teacher(s) discretion.
Mother/Father/Guardian
Date:__________________________

Signature:______________________________________________

Student
Date:______________________________

Signature:______________________________________________

PROYECTO PUENTE DE PREPARATORIA UNIVERSIDAD DE CALIFORNIA

FORMA DE PERMISO DE LOS PADRES/TUTOR
Autorizo a mi hijo/hija a participar en el Proyecto Puente. Doy permiso al Proyecto Puente de pedir
que mi hijo/a complete encuestas y participe en entrevistas sobre sus experiencias en el Proyecto
Puente de su escuela. Entiendo que cualquier informacin proveda por mi hijo/a no afectar de
ninguna manera sus calificaciones o trabajo acadmico.
Adems, doy permiso al personal del Proyecto Puente de la Universidad de California para colectar
informacin sobre el rcord acadmico de mi hijo/a en su escuela, as como en escuelas previas a las
que mi hijo/a ha asistido o a las que asistir en el futuro.
Entiendo que mi hijo/a no ser identificado/a individualmente por su nombre por ningn motivo y que
la informacin ser estrictamente annima y confidencial excepto por motivos de reclutamiento a la
universidad o reconocimiento de logros especiales.
Puente tiene mi permiso de dar el nombre y direccin de mi hijo/a a las universidades o
colegios con fin de informarle a l o ella sobre la admisin, Proyectos especiales, ayuda
financiera y otros propsitos no comerciales. Puente tiene mi permiso para dar el nombre
y direccin de mi hijo/a a organizaciones no comerciales o personas que quieran
informarle sobre becas u otros premios o reconocimientos.

Nombre del/la estudiante: _________________________ Escuela Preparatoria: Eleanor Roosevelt

High Fecha: _____________
Nombre
del
Padre/Tutor:_________________________
_________________________________

Firma

del

Padre/Tutor:

__________________________________________________________________________________________
_____________________________
PROYECTO PUENTE DE PREPARATORIA
ACUERDO ENTRE PADRES/TUTORES y el/la ESTUDIANTE
Mi hijo/a y yo deseamos participar en el Proyecto Puente de la preparatoria Corona High.
Entendemos que el propsito del Proyecto Puente es preparar a los/as estudiantes para la
universidad y su elegibilidad universitaria. Acordamos y nos comprometemos a participar lo ms
posible en el Proyecto durante su duracin de cuatro (4) aos. Comprendemos el esfuerzo que
se requiere de nuestra parte y
Estudiante
Madre/Padre/Tutor
Trabajar con mi consejero/a para prepararme para la
Asistir a juntas requeridas para los padres
universidad
madres /tutores relacionados al Proyecto
Asistir a todas mis clases diariamente y registrarme en
Puente
clases requeridas para la universidad (A-G college prep
Apoyar y ayudar a mi hijo/a en su preparacin
courses)
acadmica y sus metas profesionales, y a
Mantener calificaciones con C o mejor
participar en el Proyecto Puente
Vigilar las tareas de mi hijo/a y hablar con el Asistir a tutora cuando sea necesario
Presentar el reporte de progreso semanalmente a mis
profesor/a si es necesario
Requerir que mi hijo/a completa un reporte de padres
Esforzarme por mantener un alto promedio de
progreso semanalmente para vigilar el
calificaciones en todas mis clases
progreso acadmico
Someter
mis reportes de progreso acadmico a mi
Supervisar todas las tareas de mi hijo/a
consejero/a y padre(s) inmediatamente
Colaborar con el/la profesor/a del Proyecto
Participar
en actividades del componente Community
Puente, consejero/a y mentor/a para apoyar a
Leadership/Mentoring
mi hijo/a
Participar en eventos comunitarios con otros Participar en actividades culturales y viajes a distintas
universidades
padres de familia
estamos dispuestos a cumplir con los siguientes
Unirme con otros padres/madres/tutores en
compromisos.
dar apoyo al Proyecto Puente y a sus
Hemos ledo el Acuerdo entre Padres/Tutores y el/la Estudiante para el Proyecto Puente, y
estamos de acuerdo en esforzarnos lo ms posible para cumplir con los trminos
especificados. Entendemos que este acuerdo ser revisado peridicamente por el/la consejera
de Puente para determinar el progreso acadmico del/la estudiante.
Firma del Padre/Tutor:__________________________________________

Fecha:_____________________

Firma del/la Estudiante:______________________________________________

Fecha:____________________