APPLICATION FOR ADMISSION - Loomis Chaffee School · Yes o No o If the answer to the ... about your situation with the School Report. If, ... You are welcome to attach a narrative

APPLICANT INFORMATION This section of the form is to be completed by the parent/guardian and submitted with the application fee. Please print clearly in black ink.

Last name ___________________________________ First _____________________________ Middle ______________________

Preferred name _______________________________ Gender: o F o M Date of birth ________________________

Applicant mailing address ________________________________________________________________________________________

City _________________________________ State _________________ Zip code _________ Country _______________________

Telephone __________________________________ Student email _____________________________________________________

Country of birth _______________________________ Citizen of _______________________ Native language _________________

Do you possess dual citizenship? o Yes o No (If yes, please provide second citizenship.) ______________________________________

Are you a permanent resident of the US? o Yes o No

Do you need an I-20? o Yes o No Do you currently live overseas? o Yes o No

Current grade _______ Candidate for grade: o 9 o 10 o 11 o 12 o PG o Boarding student o Day student

Financial aid candidate o Yes o No (Please contact us if you need financial aid forms.)

List schools attended by applicant during the last three years, including his/her current school.

Year(s) attended School School address and telephone number

____________________ _______________________________ ______________________________________________________

____________________ _______________________________ ______________________________________________________

____________________ _______________________________ ______________________________________________________

Please list sibling(s) Date of birth School(s) attending/attended Applying this year

___________________________________ _____________ _________________________________________________________o

___________________________________ _____________ _________________________________________________________o

___________________________________ _____________ _________________________________________________________o

VOLUNTARY INFORMATIONThe Loomis siblings were committed to establishing a school for students drawn from diverse cultural and social backgrounds. We continue to seek students from diverse ethnic, racial, socioeconomic and geographic backgrounds as the founders of Loomis ChaVee intended. How do you describe the applicant? Please check more than one box if necessary:

o African American o European American/Caucasian

o Biracial, Multiracial o Middle Eastern American

o Hispanic American o Native American

o Asian American o Pacific Islander American

To what other schools will applicant be applying? ____________________________________________________________________

_____________________________________________________________________________________________________________

APPLICATION FOR ADMISSION Please attach photo here.

MM/DD/YY

TESTING Applicant will take/has taken the SSAT (Secondary School Admission Test Code 4672) on Date _____________________

ISEE (Date ________) PSAT (Date ________) SAT Reasoning Test (Date________) TOEFL (Date________) ACT (Date _______)

OVice of Admission • 4 Batchelder Road • Windsor CT 06095

Telephone 860 687 6400 • Facsimile 860 298 8756 • email: [email protected]

Current school

2o12–13

Parents are Married o Divorced o Separated o Never married o Mother deceased o Father deceased o

If divorced, who has legal custody of the applicant? Parent/Guardian 1 o Parent/Guardian 2 o Joint o Other (Please explain below.) o

_________________________________________________________________________________________________________________

Applicant lives with: Both Parent/Guardian 1 and 2 o Parent/Guardian 1 o Parent/Guardian 2 o Other o

If the applicant enrolls at Loomis Chaffee, please indicate which parent should receive school mail:

Both Parent/Guardian 1 and 2 o Parent/Guardian 1 o Parent/Guardian 2 o Other o ____________________________________

(Please provide complete mailing address.) ___________________________________________________________________________________

__________________________________________________________________________________________________________________

Name(s) of relatives, if any, who have attended ChaVee, Loomis or Loomis ChaVee. Include year of graduation and relationship to student.

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

Parent/Guardian 1 ______________________________________________________________________________________________

Relationship to student _____________________________________________________________________________________________

Is mailing address same as applicant’s? Yes o No o

If diVerent, please provide address. ____________________________________________________________________________________

Occupation/Title ________________________________________ _ _ Employer _____________ _________________________________ _ _

Business phone ________________________________________ _ _ _ Email __________________________________________________ _

Fax __________________________________________________ _ _ _

Home phone _____________________________________________ Cell phone _____________________________________________ __

High School ___________________________________________ _ _ _ _______________________________________ _ _ _ ______________

College(s) attended, if any, and degrees earned

_______________________________________________________ ________________________________________________________ __

Community involvement ___________________________________________________________________________________________

STREET ADDRESS / P.O. BOX CITY / STATE COUNTRY / ZIP / POSTAL CODE

o Ms. o Mrs. o Mr. o Dr. FIRST LAST (MAIDEN NAME IF APPLICABLE)

Parent/Guardian 2 ______________________________________________________________________________________________

Relationship to student _____________________________________________________________________________________________

Is mailing address same as applicant’s? Yes o No o

If diVerent, please provide address. ____________________________________________________________________________________

Occupation/Title ________________________________________ _ _ Employer _____________ _________________________________ _ _

Business phone ________________________________________ _ _ _ Email __________________________________________________ _

Fax __________________________________________________ _ _ _

Home phone _____________________________________________ Cell phone _____________________________________________ __

High School ___________________________________________ _ _ _ _______________________________________ _ _ _ ______________

College(s) attended, if any, and degrees earned

_______________________________________________________ ________________________________________________________ __

Community involvement ____________________________________________________________________________________________

STREET ADDRESS / P.O. BOX CITY / STATE COUNTRY / ZIP / POSTAL CODE

o Ms. o Mrs. o Mr. o Dr. FIRST LAST (MAIDEN NAME IF APPLICABLE)

FAMILY INFORMATION

STUDENT INFORMATIONThis section should be completed by the student. Please print clearly in black ink.

In the last three years, have you incurred serious or repeated disciplinary action or have you ever been dismissed, suspended or separated from school, placed on probation, or have you ever left voluntarily for an extended period of time? Yes o No o If the answer to the above question is yes, explain on a separate sheet, and attach it to this application. Please also have your counselor include a statement about your situation with the School Report. If, after you have submitted this form, new circumstances alter your status at school, you must notify us as soon as possible.

Through what sources did you become interested in Loomis ChaVee? ______________________________________________________

______________________________________________________________________________________________________________

Are you working with a program or consultant? (Please specify.) ___________________________________________________________

ACADEMIC INTERESTS

List your top two academic interests. ________________________________ ___________________________________

EXTRACURRICULAR ACTIVITIES/SPECIAL INTERESTSIn the grid below, please select your interests in order of importance to you. Interests may include but are not limited to arts, athletics, music, theater, dance, school clubs, communty service, or organizations. We understand that everyone is unique and diverse in many ways and that some applicants have more access to opportunity for extracurricular involvement than others. Participation Level/Leadership Plan to in grade(s) position continue?

Which of the above activities are the most important to you and why?

List any honors or awards you have received. Be specific and list everything! Include honor roll, academic awards, all-star teams, times, records, music awards, art show prizes, or anything else in which you take pride. *

* Please attach extra sheet if necessary.

Activity 6 7 8 9 10 11 12 yes or no

COUNTRY / ZIP / POSTAL CODE

COUNTRY / ZIP / POSTAL CODE

What book have you found interesting in the last year? What appealed to you about this book?

What do you think are your greatest strengths?

What do you think are your greatest weaknesses?

How would you describe your family and your role within your family?

ESSAY QUESTIONS — 200-to 300-word essay

On a separate piece of paper, please answer one of the following questions thoughtfully and thoroughly, and attach your essay to this application. If you are applying for 9th or 10th grade, please select from either question #1 or #2. If you are applying for either 11th, 12th, or for a postgraduate year, please select from either question #1 or #3. In addition, you may enclose a paper from a current class or a creative writing sample, if you wish.

1. Describe a specific challenge or obstacle you have encountered in your life, and explain what you learned from this experience.

2. Think about the community in which you live. What one thing do you appreciate most about your community? What one thing would you change? Explain why.

3. Loomis Chaffee prides itself in helping students to become their best selves. How do you see yourself developing your potential while attending Loomis Chaffee?

I have completed this application in good faith and to the best of my ability. I have answered all questions truthfully, and the application answers and essays are entirely my own work.

signature of candidate date

We authorize The Loomis ChaVee School to request, and our child’s school(s) to provide, a complete academic transcript, disciplinary record, and any other information required to make an informed admission decision.

signature of parent(s)/guardian(s) date

A $75 fee should accompany this application, or a $160 fee (drawn from a U.S. bank) if you live outside the United States, Canada or Mexico.

Tuition for 2011–12: Boarding $47,1oo; Day $35,85o

The Loomis ChaVee School does not discriminate against students on the basis of race, color, religious creed, gender, sexual orientation, national origin, ancestry or disability. This policy applies to, but is not limited to, admission, financial aid, use of school facilities and participation in school activities.

Name of candidate LAST FIRST MIDDLE

In a 2oo- to 3oo-word essay, please answer one of the following questions thoughtfully and thoroughly. If you are applying for 9th or 1oth grade, please select from either question #1 or #2. If you are applying for either 11th, 12th, or for a postgraduate year, please select from either question #1 or #3. Please complete the essay using both sides of this form. In addition, you may enclose a paper from a current class or a creative writing sample, if you wish.

1. Describe a specific challenge or obstacle you have encountered in your life, and explain what you learned from this experience.

2. Think about the community in which you live.What one thing do you appreciate most about your community? What one thing would you change? Explain why.

3. Loomis ChaVee prides itself in helping students to become their best selves. How do you see yourself developing your potential while attending Loomis ChaVee?

CANDIDATE’S ESSAY Please use black ink or attach a typed sheet.

Student’s signature ___________________________________________________________ Date ___________________

When completed, please return with application materials to:Loomis ChaVee • OVice of Admission • 4 Batchelder Road • Windsor CT 06095


Loomis ChaVee is a four-year college preparatory school located in the Connecticut River Valley, just north of Hartford. The 675 students come from all regions of the United States and from many foreign countries. Nearly 34 percent of the students receive financial assistance. Admission is very selective. The rigorous program of study should be undertaken only by able students with strong academic motivation as the curriculum is intended to prepare students for further study in selective college and university programs. Website: www.loomischaVee.org

Current English TeacherTHE COMMON RECOMMENDATION FORM

TO THE SCHOOL OFFICIAL: In an eVort to simplify the application process and eliminate unnecessary duplication of eVort, many independent schools have collaborated in the development of common recommendation forms. This form may be completed only once; photocopies will be accepted by all schools that accept the common recommendation forms. The student should provide you with a stamped, addressed return envelope for each school requesting a copy of this form. Use of the common recommendation forms will in no way compromise the student’s chances for admission. You are welcome to attach a narrative statement, but if you do so, we request that you complete the checkboxes on this form as well. Please detach the top portion of this form prior to duplication. Mail a copy of this form to Loomis ChaVee, postmarked by January 15, 2o12, or return the sealed envelope to the student to be included with his/her application.

Loomis ChaVee • OVice of Admission • 4 Batchelder Road • Windsor CT 06095 • Telephone 860 687 6400 • Fax 860 298 8756 • email: [email protected]

THE COMMON RECOMMENDATION FORM

TO THE STUDENT: Please print your name, address and school below, and give this form and a stamped, addressed envelope for each

school to your current English teacher.

Student’s name LAST FIRST MIDDLE CURRENT GRADE

Student’s address STREET CITY STATE ZIP CODE COUNTRY

TO THE TEACHER: The student named above is a candidate for admission. The Admission Committee places considerable weight on the

academic and personal qualifications of each student. Your recommendation is vital to our process. We would appreciate your most candid

and thoughtful responses.

How well do you know the student academically? ___________________________________ As a person? _______________________________________

In what years did you teach the student? __________________________________________ How large is the class? _______________________________

What course(s)? _______________________________________________________________ Is the student on block schedule? ______________________

Is this course part of a tracking system or designated as an honors or accelerated course? q yes q no

Briefly describe your course. It is especially helpful to know what texts are used and if the students are grouped by ability.

How accurately does the student read and understand what he or she has read?

How well does the student write in comparison with other students whom you have taught? Please be specific about areas of strength and weakness.

How well does the student accept advice or criticism?

Current English Teacher

Please place check marks at the points that represent your evaluation of the student in comparison to other students in his or her age group whom you have taught. If you have no fair basis for judgment, do not hesitate to say so.

ONE OF THE TOP FEW EXCELLENT GOOD I HAVE EVER (TOP 10% (ABOVE AVERAGE BELOW NO BASIS FOR ENCOUNTERED THIS YEAR) AVERAGE) AVERAGE JUDGMENT

If the student is relatively weak or strong in any areas listed above, please elaborate.

What are the first three words that come to mind to describe this student?

Please comment on this student’s character, citizenship and contributions to your community.

Please add any additional information that will give us a more complete picture of the student.

Thank you for taking your valuable time to complete this evaluation. Your reflections are an important part of the candidate’s application. All information you provide will be held in confidence and disclosed only to the Admission Committee and others deemed necessary by the assistant head for enrollment.

SIGNATURE DATE SCHOOL ADDRESS

PRINTED NAME EMAIL ADDRESS ( ) TITLE TELEPHONE

Academic potential

Academic achievement

Intellectual curiosity

Effort/Determination

Ability to work independently

Organization

Creativity

Willingness to take intellectual risks

Concern for others

Honesty/Integrity

Self-esteem

Maturity (relative to age)

Responsibility

Respect accorded by faculty

Respect accorded by peers

Emotional stability

Overall evaluation as a person

Overall evaluation as a student





Current Mathematics Teacher


TO THE STUDENT: Please print your name, address and school below, and give this form and a stamped, addressed envelope for each school to

your current mathematics teacher.



TO THE TEACHER: The student named above is a candidate for admission. The Admission Committee places considerable weight on the aca-

demic and personal qualifications of each student. Your recommendation is vital to our process. We would appreciate your most candid and

thoughtful responses.

How well do you know the student academically? ___________________________________ As a person? _______________________________________

In what years did you teach the student? ___________________________________________ How large is the class? _______________________________

What course(s)? ______________________________________________________________ Is the student on block schedule? ______________________

Next year, what math course would be the most appropriate placement for the student? _________________________________________________________

Briefly describe your course. It is especially helpful to know what texts are used and if the students are grouped by ability.

Is this course part of a tracking system or designated as an honors or accelerated course? o yes o no

Student’s mathematical background: The courses listed below suggest a sequence typical of the mathematics curriculum in many American secondary schools.

Please check those courses or list others that the student will have completed by the end of the current school year.

o Basic First Year Algebra (does not include extensive study of rational expressions, irrational numbers and quadratic equations)

o First Year Algebra (a thorough course that includes quadratics)

o Geometry

o Second Year Algebra (not including trigonometry)

o Second Year Algebra (includes numerical trigonometry through the laws of sine and cosine)

o Precalculus (including analytical trigonometry)

o Calculus (an introduction)

o Calculus (Advanced Placement AB) ____ _________________________________

o Calculus (Advanced Placement BC) ____ _________________________________

Please evaluate the candidate in relation to other students of the same age/grade whom you have taught. Please check the appropriate box for each item below.

ONE OF THE TOP FEW I EXCELLENT GOOD HAVE EVER (TOP 10% (ABOVE AVERAGE BELOW NO BASIS FOR ENCOUNTERED THIS YEAR) AVERAGE) AVERAGE JUDGMENT

Current Mathematics Teacher

Knowledge of the basic skills

Accuracy in the use of basic skills

Problem solving ability

Reasoning ability

Understanding of and appreciation for the underlying ideas and concepts

Overall performance

Willingness to accept the challenge of the more difficult problems and exercises

Command of mathematics when compared to other students whom you have taught

Please place check marks at the points that represent your evaluation of the student in comparison to other students in his or her age group whom you have taught. If you have no fair basis for judgment, do not hesitate to say so.







Academic potential





Organization

Creativity


Concern for others

Honesty/Integrity

Self-esteem


Responsibility



Emotional stability









School Report


TO THE STUDENT: Please print your name, address and school below, and give this form and a stamped, addressed envelope for each school to

your head of school, principal or guidance counselor.



Current school ______________________________________________ Previous school attended _________________________________________________

Parent signature ______________________________________________

TO THE SCHOOL OFFICIAL: The student named above is a candidate for admission. The Admission Committee places

considerable weight on the academic and personal qualifications of each student. Your recommendation is vital to our process.

We would appreciate your most candid and thoughtful responses. Please complete this form and return it in the envelope provided.

How well do you know the student academically? __________________________________ As a person? ________________________________________

Please attach:

q Final or mid-semester grades for fall term (must be included) q Recent teacher reports, if any

q Transcript of past 2 years, plus current year q A school profile, if available

q Standardized test scores

School serves grades ___________________ to _________________ Number of students in entire school _____________

In what month does your school year begin? _____________________ end? __________________

Please explain your school’s grading system. What is the passing mark? __________________ Honors mark? ____________

What percent of your students receive which grades? _____________

Does your school rank? q Yes q No Is your rank: q Approximate q Exact How many students are in the entire grade? _____________________

This candidate ranks _________ out of ________ . ___________ other students share this rank.

Does your school use a block scheduling system? q Yes q No

Are students placed in sections according to ability? q Yes q No If yes, please tell us in which level the applicant is placed for each subject.

If the student’s attendance record is not listed on the transcript, please indicate the number of days he or she has been absent or tardy each year while at your school.

If the student is not, or has not been, in good academic standing, please explain.

Has the student ever been dismissed, suspended, placed on probation, or received other serious disciplinary sanction? q Yes q No

Has he or she withdrawn from school voluntarily for an extended period of time for reasons other than health? q Yes q No

If the answer to either or both of these questions is yes, please provide a full explanation on a separate piece of paper.

School Report

Please place check marks at the points that represent your evaluation of the student in comparison to other students in his or her age group whom you have taught or advised. If you have no fair basis for judgment, do not hesitate to say so.







Academic potential





Organization

Creativity


Concern for others

Honesty/Integrity

Self-esteem


Responsibility



Emotional stability





NON-ACADEMIC RECOMMENDATION

TO THE STUDENT: Please print your name and address, and give this form and a stamped, addressed envelope to an adult who has

worked with you in an activity or special interest you enjoy outside the classroom (i.e., arts, drama, dance, music, sports, scout leader,

volunteer or paid work, etc.).



TO THE RECOMMENDER: The student named above is a candidate for admission. The Admission Committee is eager to learn from

you about the applicant’s aptitude, experiences and achievements in an activity outside the classroom. We would appreciate your candid

and thoughtful responses.

How long have you known the applicant and in what capacity? ____________________________________________________________________

In what activity have you worked with this applicant? How long has he/she been involved? What level of skill and/or responsibility does he/she display? Has the applicant received any honors or recognition in this activity?

How would you describe the applicant’s work ethic, self-esteem and personal resilience?


How well does he/she respond to criticism and advice? How does the applicant respond to setbacks?

What else would you like us to know about this applicant?

Based on your experiences, please rate the applicant as realistically as you can:



Talent in this area

Dedication

Concern for others

Leadership skills



NAME SIGNATURE DATE

ADDRESS EMAIL ADDRESS

CITY STATE ZIP CODE



OPTIONAL PARENT/GUARDIAN STATEMENT

We are delighted to consider your child for admission to Loomis ChaVee and appreciate your support in the application process. Please help us know your child better by sharing with us some of your thoughts about your child’s readiness for life in our community.

Candidate’s name __________________________________________________________________

Applicant for grade _____________________________________________________

Is_there_anything_concerning_the_sequence_of_your_child’s_schooling_that_you_think_we_should_know?__

What_has_posed_the_biggest_academic_and/or_extracurricular_challenge_for_your_child?

Name________________________________________________ _ Relationship_to_candidate____________________________

Signature__ ___________________________________________ _ Date_____________________________________________

Please_share_with_us_any_additional_personal_qualities,_strengths,_weaknesses_or_experiences_that_you_think_would_be_helpful_as_we_evaluate_your_child’s_candidacy_for_Loomis_ChaVee.

If_applicable,_is_there_an_event_that_you_would_deem_significant_in_your_child’s_life_thus_far?



Documents

APPLICATION FOR ADMISSION - Loomis Chaffee School · Yes o No o If the answer to the ... about your situation with the School Report. If, ... You are welcome to attach a narrative