APPLICANT'S NAME Last

, First M.I.

Birthday

/ / M D Y

APPLYING For GRADE:

6 7 8 (Circle One)

Millikan Affiliated Charter Middle School 2014-2015 Academy Application for all Academies
All Applicants must: (a) Complete the Intent to Apply found at www.millikanmiddleschool.org (b) Provide a self addressed stamped envelope upon application submission (c) Complete Academy Application: (page 1-2) and attach: i) -a copy of last three years report cards ii) -a copy of last 2 years CST scores (or any other standardized test scores) iii) -copies of other supporting materials (IEPs, , GATE Identification, Independent School assessments/notes, etc.) (d) Provide Teacher Recommendation Form (pages TR 1&2) to current school teacher with addressed, stamped envelope NO APPLICATION WILL BE CONSIDERED WITHOUT THE REQUIRED ATTACHMENTS Math and Science Academy candidates must: - take the math placement test on 2.11.14 (for priority placement) or 4.8.14 from 3:30 P.M. to 5:00 P.M. to qualify
(Candidates taking the math placement test for the Math or Science Academy must be at Millikan, Burrill Hall, at 3:30 P.M. on 2.11.14 (for priority placement) or 4.8.14, 3:30 P.M. to 5:00 P.M.)

Performing Arts and Film Candidates may submit: i) a resume or complete description of training in dance, music, or theatre ii) a portfolio of work, where applicable (e.g., costume design, edited film, story boards, music composition)

Directions:

Applicant may apply for only ONE program. Letters indicate submission procedure* for each program.
If not accepted into the Academy of choice, please forward this application to the following should there be space available: (Choose 1) ___ ___ ___ ___ ___ Civics Academy Cinematic Academy Math Academy Performing Arts Science Academy

Priority Submission Requirement ___CIVICS ACADEMY a, b ___CINEMATIC ACADEMY a, b ___MATH ACADEMY a, b, c ___SCIENCE ACADEMY: A STEM SCHOOL a, b, c ___PERFORMING ARTS a, b, d, e

*Submission procedure requirements: a) All applicants must have completed the Intent to Apply found at www.millikanmiddleschool.org, or request a hard copy from the Performing Arts Magnet Office at 818-528-1610 b) Mail or hand carry to: Millikan MS, 5041 Sunnyslope, Sherman Oaks, CA, 91423 Attention: Larry Link c) Must take math placement test on 2.11.14 (for priority placement) or 4.8.14 from 3:30 P.M. to 5:00 P.M. to qualify for Science or math Academy d) Schedule and complete performing arts placement assessment. (Schedule by calling performing Arts Magnet office at 818-528-1610) e) Application and all additional materials must be received by Friday, January 31, 2014 deadline OR 1 week prior to placement assessment if prior to January 31, 2014. Application submission begins Monday, December 2, 2013 We will begin accepting applications on Monday, December 2, 2013. For priority consideration, the final deadline for receipt of academy applications is Friday, January 31, 2014 regardless of dates for interviews, math exam, or performing arts assessments. All applications submitted after the final deadline of Friday, January 31, 2014 will be considered after earlier applications have been accepted or denied. Invitation to Interview, Exam or Placement Assessment Upon review of the application, Science, Civics and Cinematic Arts Academy candidates will receive notice to interview. Math Academy does not require an interview. After December 2, 2013, Performing Arts Academy candidates will need to call and make an appointment to audition. (Please
see the Performing Arts page at millikanmiddleschool.org for additional instructions.)

Acceptance Letters Letters regarding status of applications to any academy will be sent via email beginning March 3, 2014. Students have 10 days from the date of notification to accept a seat in an academy, or the seat will be offered to another student.
Millikan Middle School, 5041 Sunnyslope Ave, Sherman Oaks CA 91423 (818 528-1600) millikanmiddleschool.org Academy Application Page 1 2014-2015

APPLICANT'S NAME Last

, First M.I.

Birthday

/ / M D Y

APPLYING For GRADE:

6 7 8 (Circle One)

NOTE: Placement in an Academy DOES NOT guarantee acceptance into Millikan Affiliated CharterMiddle School. You must also meet residency requirements, OR you must apply for and receive a transfer permit (i.e. SAS etc.)

Current School __________________________ Current Grade _____________ Current Teacher _________________________ Home Address ____________________________________________________________________________________________
Number / Street CITY ZIP CODE

Millikan MS Resident?

Yes

No

(To find school of residence, got to http://rsi.lausd.net/ResidentSchoolIdentifier/)

Home phone

Contact Cell Phone

This is the primary form of communication. Please print carefully

Alternate Phone

BEST CONTACT EMAIL ADDRESS: __________________________________________ Parent/Guardian #1:

First Last Email Phone

Parent/Guardian #2:_
First Last Email Phone

SPECIAL SERVICES Does your student receive special education services at his/her current school? Has your student ever had an IEP at a previous school? Does this student have a Section 504 Plan at his/her current school?

CIRCLE ONE Yes Yes Yes No No No

Has this student been identified Gifted or Talented by LAUSD? Highly Gifted Voice Intellectual Dance High Achievement Drama Specific Subject Music Art

Yes

No

Please confirm you have attached the following: I have attached a copy of my childs last 2 years California Content Standardized Test Scores (CST).
If your child has not taken this test, please attach copies of the results of whatever "achievement tests" and "ability tests" your child has taken in the last two years.

I have attached a copy of my childs last 3 years report card or progress report I have attached (if applicable), a copy of my childs State Identified Gifted verification, 504, or IEP
I understand that if my child is accepted into a Millikan Academy, enrollment is not guaranteed unless we meet residency requirements, OR apply for and receive a LAUSD Transfer Permit (e.g. SAS, School of Choice, etc). I have given the Teacher Recommendation Form and a pre-addressed, stamped envelope to my childs current teacher. I understand that Teacher Recommendations are confidential and are mailed by the teacher directly to Millikan Affiliated Charter Middle School. If (I/my child) am accepted into this Program, I understand that (I/my child) am expected to maintain a GPA above 3.0 with no U in any subject, attend all field trips, participate in all Academy activities both in and outside of the classroom (including fundraising), and demonstrate responsible and respectful behavior at all times.

STUDENTS SIGNATURE _____________________________________________ PARENT'S SIGNATURE _____________________________________________

DATE _________________ DATE _________________

Millikan Middle School, 5041 Sunnyslope Ave, Sherman Oaks CA 91423

(818 528-1600)

millikanmiddleschool.org

Academy Application Page 2

2014-2015