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Aft-student-application-summer College of Education

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Document Name: AFT-Student-Application-Summer-20180423.Docx Page 1 of 5
College of Education
Academy for Future Teachers Student Application
INTRODUCTION
College of Education 504 College Drive, Albany, GA 31705
Office Billy C. Black Building Room 244
Telephone: (229) 430-4716 Fax: (229) 434-7114
DIRECTIONS: This application must be typed, and all information must be completed. Applicants must return the following
document with their completed application, A letter of recommendation from a teacher or guidance counselor
For more information email Dr. Erica DeCuir, AFT Director, at Erica.decuir@asurams.edu or call 229-430-4716
PERSONAL DATA
STUDENT NAME: ______________________________ ___________________________ ___________ DATE: _____________________
Last First Int. MM/YY/DD
E
THNICITY (USED FOR STATISTICAL AND RESEARCH PURPOSES ONLY): _________________________ AGE: __________________________
GRADE IN SCHOOL: ______________ GENDER _________________________ T-SHIRT SIZE: _____________________________________
E-MAIL: ________________________________________________________________________________________________________
HIGH SCHOOL INFORMATION
ADDRESS _____________________________________________ _________________________________________________________
Street Number Street Name
__________________________________________ _________________________________________________ ________________
City County Zip
HOME ADDRESS
ADDRESS ____________________________________ _________________________________________________ ________________
Street Number Street Name Apt Number
__________________________________________ _________________________________________________ ________________
City State Zip
TELEPHONE: _________________________________ _____________________________________ _____________________________
Home (Area Code Number) Parent’s Mobile Student’s Mobile
I am definitely considering a career in science, technology, engineering and/or math. (Y or N) □ Yes □ No
If no, please describe why you are interested in AFT: __________________________________________________________________
Albany State University College of Education
Academy for Future Teachers Student Application
Document Name: AFT-Student-Application-Summer-20180423.Docx Page 2 of 5
PARENTAL/GUARDIAN INFORMATION
NAME: _____________________________________________________________ RELATIONSHIP TO STUDENT: ______________________
Last First
NAME: _____________________________________________________________ RELATIONSHIP TO STUDENT: ______________________
Last First
STUDENT QUALIFYING INFORMATION
Please list your interests, hobbies, and experiences that have prepared you for this summer experience opportunity:
Describe any other extracurricular activities that you are involved with:
Do you mentor or work with students younger than yourself? If so, in what ways?
Are you a returning AFT participant? □ Yes □ No
Do you have an automobile at your disposal?
□ Yes □ No
Albany State University College of Education
Academy for Future Teachers Student Application
Document Name: AFT-Student-Application-Summer-20180423.Docx Page 3 of 5
Provide the names and grades of the science and math courses you took last year:
___________________________________________________________________________________________ _________________
Courses Name Grade.
___________________________________________________________________________________________ _________________
Courses Name Grade.
___________________________________________________________________________________________ _________________
Courses Name Grade.
Have you taken the SAT/ACT yet? □ Yes □ No
If so, what was your most recent score? _________________________________________________________________
Who will be writing your recommendation for acceptance? (check one)
□ counselor □ teacher
Albany State University College of Education
Academy for Future Teachers Student Application
Document Name: AFT-Student-Application-Summer-20180423.Docx Page 4 of 5
PARENT/ GUARDIAN AFT PERMISSION/ RELEASE FORM
I understand that my son/daughter may participate in the 2018 Academy for Future Teachers. I give my
son/daughter permission
to participate in all program activities including field trips, internet activities and other
extracurricular events which the Academy for Future Teachers deem necessary. During the extended course of the
program, Academy for Future Teachers may publish
brochures, newsletters and other materials for information and
publicity. Survey data will also be collected for research purposes.
I hereby consent to my child’s name, likeness, pictures, or voice being used by the university, AFT, the school system
or in the
media. I also give permission for my child to be surveyed for the purpose of research. I support my
son/daughter in his/her
learning and release the Academy for Future Teachers, my child’s school system and
Georgia State University of any medical or
legal liability.
I understand that my son/daughter is expected to attend the summer academy daily and to be on time to every
scheduled class. He/she is only allowed one (1) excused absence. Late Arrivals: Any student reporting to the
academy after 8:30 AM is considered tardy. Three tardies equal the only excused absence permitted. Students with
more than 3 tardies will automatically be withdrawn from the program. Students are expected to schedule all
appointments after 1:00 PM. A note must be given to the site coordinator or designee prior to or on the day of
any early dismissal along with a parent/guardian signature and a working guardian phone number for verification.
Any student who leaves the site prior to instructor dismissal and without permission will be withdrawn from AFT
201 with no further warning. AFT will not accept responsibility to return students to campus early on field trip days.
Every effort is made to have them back on campus by 1pm.
I understand that there is a $150 stipend associated with my child’s successful participation in the program. This
stipend will be
paid to students who attend according to the rules stipulated and fully complete all assigned work.
I understand that my son/daughter is expected to behave in accordance with school and university rules and
regulations on and
off campus. Rules around in-class use of cell phones, electronic devices, consumption of
food/beverages and chewing gum may
be set by the instructor. Serious misbehavior such as disrespect to faculty or
staff, use of obscene language, cutting classes,
gambling, leaving class or school without permission, carrying or
possessing knives and/or other weapons, and deliberate acts of
vandalism, will result in withdrawal from AFT 2018.
___________________________________________________________________________________________ _________________
Parent/Guardian’s Signature Date
Albany State University College of Education
Academy for Future Teachers Student Application
Document Name: AFT-Student-Application-Summer-20180423.Docx Page 5 of 5
AFT STUDENT CODE OF BEHAVIOR AND RELEASE FORM
Dress: I understand that appropriate dress, neatness, and cleanliness are expected of all students. Any article of
dress that
distracts or draws unfavorable attention or threatens health or safety is considered out of order.
Inappropriate dress may result in
the student being sent home and counted absent for the day. Appropriate dress
will be strictly enforced for specific activities such
as practice teaching days.
Attendance: I understand that –in order to receive my stipend - I am expected to attend and participate fully in all
AFT activities
and to be on time to every scheduled class. Absences are strongly discouraged with no more than one
permitted. I understand
that more than one absence could revoke my stipend. I will communicate early and provide
notice and/or documentation around
any absence.
Late Arrivals: Any student reporting to AFT after 8:30 AM is marked tardy. Three tardies constitute one absence. I
understand
that AFT may revoke my stipend for the equivalent of more than one absence. Extended tardies also
put my stipend at risk.
Early Dismissal: Students are expected to schedule all appointments after 1:00 pm. Because of field trips and
activities all over
ASU, students may not be available for pick-up on short notice. A note must be given to the Team
Leader prior to or on the day
of the early dismissal along with a parent/guardian signature and a guardian working
telephone number for verification. Any
student who leaves program activities prior to instructor dismissal and
without permission may be withdrawn from the AFT 2018
with no further warning and will lose their stipend.
Stipend: I am aware that there is a $150 stipend associated with my successful completion of the AFT 2015 program.
This
stipend is paid only to students who attend according to the rules, participate in all activities, complete
assigned work, and
provide necessary documentation.
I understand that I am expected to behave in accordance with school rules and regulations on and off campus. Rules
around
consumption of food/beverages and gum in the classroom will be set by the instructor. Serious misbehavior
such as disrespect to
faculty and staff, use of obscene language, cutting classes, gambling, leaving class or school
without permission, carrying or
possessing knives and/or other weapons, and deliberate acts of vandalism, will result
in withdrawal from the AFT 2018.
I agree to turn off my cell phone, I-Pod, I-Pad, and any other electronic item during ALL AFT classes and AFT events. I
will be
given breaks during the morning to check calls and messages. AFT faculty and staff have final authority
around use of these
devices and may collect and retain them until class is dismissed without further warning if they
are a distraction to me or those
around me.
I understand by submitting this application, I agree to the above code of behavior and release form.
___________________________________________________________________________________________ _________________
Student’s Signature Date
ADDITIONAL INFORMATION
Applicants must return the following document with their completed application:
A letter of recommendation from a teacher or guidance counselor.
For more information email Dr. DeCuir, AFT Director, or call 229-430-4716.
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Completed 20 February 2020

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