Summer is here!

Have you ever wondered what it would be like to be a college student? Join us for a fun 8week information session at Mesa College to learn the inside scoop about college and to meet new friends!

Join the 8-week Personal Growth 120:

June 17th August 10th 7:00am 10:25am OPTION #1: Mondays & Wednesday OPTION #2: Tuesdays & Thursdays Deadline to sign up: Monday, June 3rd

To learn more, contact GEAR UP Coordinator, Leezel Ramos LeezeLr@ucsd.edu Madison High School, room 709

Dear GEAR UP class of 2014 and Parents,

If college is in your future, then you wont want to miss this opportunity to attend a Personal Growth class with the San Diego Community College District (SDCCD) this summer. Having a pre-college experience, especially with a course to help you prepare for your maturation into adulthood and your experience at college will undoubtedly have a positive impact on you as you begin your college journey. There is NO charge for this unique experience. The Personal Growth course will show students what they can expect when they attend college and what theyll need to do to get there. Student attendance at each college listed will depend on each students current high school. Students will need to complete the GU Application, the Supplemental SDCCD Application, and Liability/Release forms. Students enrolled in Personal Growth (PERG) 120 College Success and Lifelong Learning will: Identify personal and academic goals Research and review academic options Explore available resources: Child development center, Disability Support and Services, EOPS (Extended Opportunity Program), Academic and Athletic Programs, Transfer and Career Center Develop or enhance Study tips and successful ways to complete classes Learn the consequences of dropping versus withdrawing from a class

Dates/Times
OPTION #1: Mondays & Wednesday June 17 August 10 7:30AM 10:254AM OPTION #2: Tuesdays & Thursdays June 17 August 10 7:30AM 10:25AM

Location
Mesa Community College Room 14 213 *CRN54823

Mandatory Attendance
If a student is accepted, attendance is MANDATORY. Students who pass the course will be given college credit. Likewise, students who do not attend or stop attending will fail unless they follow the procedures for officially withdrawing by the deadline. Absences will affect class AND test performance.

Mesa Community College Room 14 213 *CRN54837

PERG 120 College Success and Lifelong Learning 3 hours lecture, 3 units Letter Grade or Pass/No Pass Option Advisory: English 48 and English 49, each with a grade of C or better, or equivalent, or Assessment Skill Levels R5 and W5. Limitation on Enrollment: This course is not open to students with previous credit for Personal Growth 127. This course teaches success strategies to enhance academic and lifelong learning skills. Students explore topics such as motivation and attitudes, values, goal setting, decision-making processes, critical and creative thinking, personal health topics, interpersonal communication, developmental psychology, and learning and personality theories, as well as other techniques for maximizing their abilities to succeed as lifelong learners. Students apply these topics as they relate to their self-development as integrated physiological and psychological entities and acquire strategies to effectively deal with issues in their personal lives and educational and career plans. (FT) Associate Degree Credit & transfer to CSU and/or private colleges and universities. UC Transfer Course List.

APPLICATION DUE: MONDAY, JUNE 3, 2013

Summer 2013 PERG 120 College Success and Lifelong Learning

APPLICATION PAGE Please type or write NEATLY and LEGIBLY in BLUE or BLACK INK Student Name: ________________________________________________________________________ Last First Middle Initial Parent/Guardian Name: _________________________________________________________________ Last First Mailing Address: _______________________________________________________________________ Address Unit/Apt (if applicable) ______________________________________________________________________ City State Zip Phone #: (________)________________ Birth Date: _____/_____/______
Month Day Year

Gender: Male Female

Alternate Phone #: (________)________________ Student ID Number ________________ Age: _____ Expected Date of Graduation: _____/______
Month Year

School you currently attend in 2012-2013:___________________________________________________ Student Email Address (One character per box)

Do you qualify for free and/or reduced lunch at school? Number of people in household: __________ Yes No Annual Family Income $__________________________

Are you a first generation college-bound student? Meaning, your parents and older generations didnt complete a college degree and you/your generation would be the first to earn a college degree? Yes No Please check all with which you most closely identify: African American Asian/Pacific Islander Filipino/a Latino/Hispanic Native American/Alaskan Native White/Caucasian Other, specify: __________________ Are you a current participant in any of the following outreach programs? UC EAOP Educational Talent Search Upward Bound Other, specify: ____________

______________________________________ Parent Signature

______________________________________ Student Signature

APPLICATION DUE: MONDAY, JUNE 3, 2013

San Diego Community College District

Supplemental Application and Certification of Special Part-Time High School Diploma Student
City Name: Grade Level: Mesa Miramar Fall Spring Summer Year 20 CSID Number: Expected High School Graduation Date:

Student s Name (PRINT) ___________________________ CSID Number _

Admission Regulations: 1. Students must have completed the 10th grade. 2. A student may take a maximum of one course per semester or session. This maximum includes classes at City, Mesa, Miramar Colleges and ECC (excludes High School Honors classes). 3. High school students must satisfy course prerequisites and eligibility requirements. Proof required contact the college for information. 4. Enrollment in Physical Education classes will not be permitted. 5. The course must be advanced scholastic or technical (college degree applicable). Contact the college Admissions Office for details. 6. Students will be given college credit for all courses. Grades will be part of the students permanent college record. Academic Standing Rules: 1. Students must maintain a 2.0 grade point average each semester in all college work. 2. If the number of units of W, I and NP exceed 40% in any semester or session, the student will be academically disqualified. 3. A special part-time student whose grade point average falls below a 2.0, or who do not complete 60% of all units attempted will not be permitted to re-enroll without approval from a college counselor. I have read the Admission regulations and Academic Standing Rules stated above and understand the eligibility requirements thereof. Students Signature Date HIGH SCHOOL CERTIFICATION (to be completed by the high school) This is to certify that ________________________________ at _________________________ school has my recommendation to attend community college based upon his/her ability to benefit from advanced scholastic work in accordance with California Education Code Section 48800.5. He/she is approved to attend the course listed below with the San Diego Community College District during the: Fall Spring Summer Year 20_________
Course Reference Number Class Meets Subject Area Units Hours (Begin/End) M T W Th F S

Course Number

I certify that the course is not available at the school of attendance. I certify that this student is not being claimed for ADA if the class meets during the regular school day. I further certify that in conformity with Title 5, no more than 5% of this students class is participating in concurrent enrollment at a community college, if the student is enrolling in a summer class, and that enrollment is consistent with the admission regulations on reverse side of this form. PRINT Name Signature School Telephone ( )
High School Seal/Stamp

Principal/Vice Principal Date:

PARENT/GUARDIAN PERMISSION FOR SON/DAUGHTER TO ENROLL IN A COLLEGE CLASS

(to be completed by the Parent/Guardian)

I grant permission for my son/daughter, PRINT Name

To enroll in the indicated class below during the Fall Spring Summer Year 20_______ Indicate College: City Mesa Miramar ECC

I understand that in accordance with State & Federal Law, I will not have the right to access my childs college records without his/her written consent or a court order. Parent/Guardian PRINT Name Signature Date Parent/Guardian Signature Required for all High School Students - No Exceptions. MINORS AUTHORIZATION CONSENT FOR MEDICAL TREATMENT
(to be completed by the Parent/Guardian)

In cases of illness, injury or life threatening emergencies I hereby authorize San Diego City, Mesa or Miramar College Student Health Services staff to assess and treat my son/daughter. Permission is also granted to provide referral to outside physician and facility, if deemed necessary by health care providers. This permission does not cover special elective procedures requiring local anesthesia (suturing, biopsy, toenail removal). Parent/guardian will be contacted via telephone/sent consent form for permission to perform these procedures. Per State law, parental permission is NOT required in cases of treatment of sexually transmitted disease and contraception (birth control). Nominal fees may be charged for laboratory, pharmacy and special procedures deemed necessary by health care providers at the college Student Health Services. Payment of these fees will be required at the time services are received. I authorize the college to provide medical treatment to my son/daughter in case of emergencies. Parent/Guardian PRINT Name Signature Date

ACCESS TO STUDENT RECORDS

(to be completed by the student)

I, ____________________________________, hereby authorize access to all of my academic records maintained PRINT full name by the San Diego Community College District to the individual or agency listed below:

This authorization will be effective beginning (term) Students Signature

through (term) Date

PTHS-0709

Summer 2013 PERG 120 College Success and Lifelong Learning

RECCOMENDATION FORM STUDENT INSTRUCTIONS Give this form to a teacher, counselor or unbiased adult, such as a coach or minister. Once it is completed, be sure to get it from the recommender and include it with your application packet. Student Name: ________________________________________________________________________ Last First Nickname (Optional)

Dear teacher/counselor/program coordinator,

The above student is applying for admission to Community College. If selected, the student will attend an intensive, course held this June August at the respective community college. After you complete the recommendation, please return it to the student to submit. If youd like it to remain confidential, you can give it to the student in a sealed envelope with signature. Please rate the student in the following categories: Academic/Intellectual Ability Writing/Speaking Ability Willingness to Learn Behavior in class, sports, etc. Maturity Responsibility Write any additional comments below or attach a separate sheet. Exceptional Above Average Average Below Average No basis for judgment

Recommenders Name: _________________________________________________________________ Phone Number or Email Address: _________________________________________________________ Position or Title: _______________________________________________________________________ School or Organization: _________________________________________________________________

____________________________________________________ Recommender Signature

____________ Date

APPLICATION DUE: MONDAY, JUNE 3, 2013

Summer 2013 PERG 120 College Success and Lifelong Learning

ESSAY How would you use the Personal Growth Class to prepare you for college? (Include a separate one-page, typed essay with this application) ESSAY Waived

Application Checklist Be sure to include: Application page San Diego Communication College District Supplementary Application Waiver of liability signed by student
(and parent if student is not 18 years old as of the due date)

High school transcript Recommendation form Essay ESSAY Waived Submit Application

Submit via any ONE (1) of the following methods:

Drop Off Drop off your hard copy application to GEAR UP Coordinator, Ms. Ramos, at Madison High School in room 709 on/by JUNE 3, 2013

Mail

Cal-SOAP Attn: Community College Personal Growth 6735 Gifford Way, Room 14 San Diego, CA 92111 Scan/email: 858-569-1136, Attn: J. Suber (After faxing, call 858-569-1866 to confirm)

Deadline if mailing: Must be postmarked by JUNE 3, 2013 Emailed on/by JUNE 3, 2013 Deadline if faxing: Must be faxed on/by JUNE 3, 2013

E-mail Fax

APPLICATION DUE: MONDAY, JUNE 3, 2013