Personal Information

First Name *

Last Name *

Email Address *

Street Address *

City *

State *

Zip Code *

Phone Number *

Home School *

Grade level (2015-2016) *

Which Academy are your currently in? *

What is your current GPA? (Estimate if you are not sure) *

Please fill in the scores below for the tests you have completed. (Please estimate if you are unsure.)

What were your scores on the EXPLORE test?

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Math	-
Science	-
Reading	-
English	-
Composite Score	-

What were your scores on the EXPLORE test?

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Math	-
Science	-
Reading	-
English	-
Composite Score	-

What were your scores on the ACT?

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Math	-
Science	-
Reading	-
English	-
Composite Score	-

Please type in your current grade for the following courses you are taking now.

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Math	-
Science	-
Reading	-
English	-
Social Studies	-

Which courses are you interested in?

Please select the courses you are interested in. (Please note that scholars signing up for two courses will have priority over those taking one.) *

Essay

Please explain why you are a good candidate for the afterschool college program. *

Disclaimer and Signature

The college classes offered are Communications 105 (COM105), Psychology 105 (PSY 105), Ethics and Technology (PHI 215D), Computer Applications and Hardware (CIS 113) and the Academy Help Session. These classes are Monday through Friday from 3:00-4:15pm. Additional classes may be offered as needed.

Scholars that are selected to be enrolled in the college courses will be responsible for following the policies of Thomas More College concerning academic integrity, payments, and drop dates.

The cost to attend the Thomas More College course(s) is $200 per course, plus the cost of books. Again, this is payable directly to the bursar at Thomas More College.

All college courses will take place at the Edgewood Campus:

The Kenton County Academies of Innovation & Technology

3234 Turkeyfoot Rd.

Edgewood, Kentucky 41017

Scholars will be provided a bus from their home High School to the Edgewood campus. The buses will pick up at each high school at 2:30pm and drop off at the Edgewood Campus. Classes start at 3:00pm. Scholars must provide their own transportation home from Edgewood. Scholars are not permitted to ride with other scholars.

The signatures below acknowledge that the parent and scholar are in agreement with the statements and information provided on this form.

We look forward to beginning your college experience!

Scholar Signature *

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Parent Signature *

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