Fill - Free fillable Application MSJC Honors Enrichment Program Application PDF form

Revised 7/1/19

MT. SAN JACINTO COLLEGE HONORS ENRICHMENT PROGRAM APPLICATION FORM

Part I: Personal Information

Name: ___________________________________ Preferred Name ___________________________

Mailing Address: ____________________________________________________________________

Number and Street City, State, Zip

________________ ___________________________ ___________________________

Cell Phone Number MSJC Email Address Personal Email Address

Note: Your signature here authorizes college personnel to verify your coursework and GPA for courses taken at MSJC.

_______________________________________________ ____________________________ ______________

Signature Authorizing Electronic Verification Student ID# Date

Part II: Status of Applicant

All applications must include:

1. Transcripts (unofficial college or official high school)

2. Personal statement

3. Education Plan or list of several classes that the student can take as honors

4. Evidence of enrollment in or completion of English 101 (via transcript) or signed pledge

indicating planned enrollment in English 101 during first semester in the program (included at

end of application).

SELECT ONE OF THE FOLLOWING OPTIONS TO APPLY TO HONORS (Check and complete one)

□ Recommendation and Meeting Option

 A letter of recommendation from a teacher,

counselor or principal familiar with your academic

work. The letter should specifically reference your

critical thinking skills.

 Brief meeting with one of the Honors Co-Directors.

□ Portfolio and Meeting Option

 Portfolio of work that includes a minimum of

3 items that demonstrate your academic

potential. Items in portfolio may include (but

are not limited to) writing samples, artwork,

performance pieces, news reports,

multimedia presentation, etc.

 Brief meeting with one of the Honors Co-

Directors.

□ Qualifying GPA and Contact Names

 Transcript must indicate qualifying GPA (3.5

unweighted GPA for High School, or 3.3 GPA for

College-level coursework), or better unweighted

GPA or SAT 1890 (out of 2400), or SAT 1260 (out

of 1600) or ACT 28 (out of 36).

 Names and contact information of two MSJC

faculty members who will comment on behalf of

your application to the program (letters of

recommendation not required)

Name/Email__________________________________

□ Veteran Status

 Veteran or Active Duty in the US Military.

 Signature of MSJC Veterans Center Staff or

Faculty

Signature _____________________________

For program use only

Date Accepted: _________

Colleague: _____________

Email: _________________

Canvas: ______________

Gazette: ______________

Database: _____________

Notes:

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Revised 7/1/19

Part III: Questionnaire

 What is your major or anticipated major: ______________________________________________

 Are you planning on transferring or entering the workforce upon completion at MSJC: __________

 If you are planning on transferring, what are your top 3 transfer institutions?

_________________, ____________________, ___________________

 While we encourage all students to complete the honors program, completion is not required for

membership. At time of application, are you planning on completing the Honors Enrichment Program (see

list of requirements on page 3) Yes _________ No ___________

 List the five courses you plan on taking to complete the honors program. (www.msjc.edu/honors)

 ____________________, _____________________, ___________________, ____________________,

_____________________

 How did you find out about the program? ___________________________________________________

 From which high school (include city) did you graduate?

____________________________________________________________________________________

Part IV: Personal Statement

The Honors Enrichment Program core values are inclusivity, leadership, academic rigor and research,

engagement, positive transgressive behavior (as evidenced by creativity, innovation, risk taking, challenging norms

and standard narratives), and holistic well-being. Which of these value or values resonates with you, and what have

you done or what do you want to do that somehow relates to this value or these values? The statement should be

typed, a minimum of 250 words, and attached to the completed application.

Part V: Program Expectations

By submitting this application, you are agreeing (should you be accepted into the Honors Enrichment Program) to

the following:

1. Maintaining a 3.3 GPA while in the Honors Program and a 3.0 GPA in Honors classes.

2. The completion of at least one honors class per semester beginning the first full semester the student is in

the program (students may petition for a one semester reprieve from this requirement due to extenuating

circumstances).

3. Recognition that the Honors Enrichment Program does not guarantee that all students will be able to

complete the Honors Enrichment Program.

4. Following acceptance into the Honors Program, each new Honors Program student is required to schedule

an academic counseling session with one of the Honors Program counselors. Thereafter, academic

counseling appointments must be scheduled once each semester with the Honors Counselor.

5. All honors students are expected to abide by the Mt. San Jacinto College Student Code of Conduct.

Failure to meet these requirements will result in the student being placed on probation for a semester to allow them

to improve their standing or risk dismissal from the program.

__________________________________________ _________________

Signature of Student Date

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Revised 7/1/19

Part VI: Further Instructions for Applicants

_____ (please initial after reading)

In order to complete the Honors Enrichment Program at Mt. San Jacinto College, Honors students must complete a

minimum of 5 Honors classes worth 15 units. Of these classes one must be the HEP Honors Studies Course (201,

202, or 203) and the other 4 must be in a minimum of three different disciplines. Students will maintain a 3.3 overall

GPA and a 3.0 Honors GPA. Completing students will have passed or tested out of English 101 or 101H and pass

or tested out of Math 96. Completing students will also have completed an exit survey and 200 points of Honors

Activity Points (see Canvas course shell for qualifying events).

_____ (please initial after reading)

Students who are members in good standing in the Honors Enrichment Program will usually receive Priority 5

registration as per the MSJC College Catalog. However, early registration is not guaranteed by the Honors

Enrichment Program and usually only becomes available after the student has been a member of the program for a

full semester.

_____ (please initial after reading)

Acceptance into the program is dependent on a variety of criteria such as the following: qualifying GPA, quality of

the letter of recommendation or references, the quality of the personal statement, the student’s portfolio, veteran’s

status, meeting with Honors Co-Director’s and the suitability of the Honors Program for the student’s

academic/career path.

Honors Program applications are accepted year-round. Applications will be reviewed shortly after the following

enrollment window deadlines:

Friday of the First Week of August Friday of the Second Week of February

Friday of the Second Week of September Friday of the First Week of May

Friday of the Third Week of November Friday of the Second Week of June

Friday of the First Week of January

Acceptance letters will be emailed following review and approval by an Honors Program Coordinator. If you have

questions, please contact Erik Ozolins, MVC Coordinator at 951-639-5725 (eozolins@msjc.edu) or Christina

Yamanaka, SJC Coordinator at 951-487-3522, (cyamanaka@msjc.edu).

PLEASE SUBMIT THIS FORM AND ALL REQUIRED MATERIAL TO

For MVC

Erik Ozolins

MVC Honors Program Coordinator

Mt. San Jacinto College

28237 La Piedra Rd.

Menifee, CA 92584

For SJC

Christina Yamanaka

SJC Honors Program Coordinator

Mt. San Jacinto College

1499 N. State Street

San Jacinto, CA 92583

Completed applications and supporting materials may also be turned in at the Learning Resource Center on either

campus, Erik’s office (MVC -Room 456), or Christina’s office (SJC – Room 1503) or to Honors Staff at either Honors

Space (Room 1253 at SJC or Room 830 at MVC). If you submit your application to the LRC, please be sure to email the

appropriate Honors Coordinator to let them know your application has been turned in.

English 101 Pledge

□ I have fulfilled the English 101 requirement by passing English 101 with a grade of C or

higher, taking the equivalent at another college, or have placed into a higher level English

class.

□ I pledge to take ENG 101 during the first semester of the program

________________________________________ ______________________________

Signature Date

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Revised 7/1/19

MT. SAN JACINTO COLLEGE PHOTO RELEASE FORM

Honors Applicants

Periodically we take photographs of our Honors members during Honors classes and Honors events. We use these

photographs to help us advertise the program and educate our local community about the goals and benefits of

Honors. If you are accepted into the program, we may have the opportunity of photographing you. If you are

willing to allow us to use your image in Honors media materials, please consider reading and signing the MSJC

photo release form below. Signing the photo release form is optional and does not influence our evaluation of your

application.

Photo Release (Check one of the two boxes listed below)

□ I, the undersigned, give Mt. San Jacinto College permission to use my photo, video image, and/or voice for

advertising, marketing, or editorial purposes. I hereby release, waive and hold harmless any and all claims arising

out of the use of said image, voice, related story or editorial by the College and/or its authorized designee, such as

cable or network TV stations, radio stations, newspapers, magazines or other printed publication, or for use in a

college brochure, catalog, schedule of classes, advertisement, promotion, documentary, feature story or film.

I warrant that I am at least eighteen (18) years of age. If I am under the age of eighteen (18), this form must be

signed by a parent or guardian. I have read and fully understand the above statements.

________________________________________ ______________________________

Print Name Date

________________________________________________

Signature

________________________________________________

Signature of Parent or Guardian if under age 18

________________________________________________

Address

_____________________________________________________________________________

City, State, Zip

_______________________ ____________________________________

Phone E-mail address

□ I do not wish to sign the MSJC Photo Release form at this time.

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