APPLICATION PACKET

Christiana Middle School Honors Academy
Christiana High School
190 Salem Church Road
Newark, DE 19713
www.ChristianaHS.org/MSHA

TABLE OF CONTENTS

2017-2018 APPLICATION GUIDELINES ..................................................... 3
STUDENT APPLICATION ........................................................................... 4
TEACHER RECOMMENDATION FORM ..................................................... 6
TEACHER RECOMMENDATION FORM ..................................................... 8
EXTRA-CURRICULAR ACTIVITIES FORM ................................................... 9
PARENT STATEMENT FORM .................................................................. 11
ADMISSIONS RUBRIC ............................................................................ 12
APPLICATION CHECK LIST ...................................................................... 14

Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 2 of 14

2017-2018 APPLICATION GUIDELINES
(2017-2018 school year—6th Grade only)

The Christiana Middle School Honors Academy requires a high degree of commitment to academic and
extra-curricular activities. Our vision offers selected middle school students the opportunity to become
academically accomplished, confident, and well–rounded. Selected students will be educated using a
rigorous curriculum focused on developing core knowledge, critical thinking and reasoning skills. This
will be accomplished by providing each student with a smaller learning community that builds
confidence and knowledge which will enhance their individual high school experience. Students will
participate in Honors level core subjects (ELA, Math, Science, and Social Studies), will be required to
take a foreign language, and must participate in a performing arts elective.
Applications will be accepted for the 2017-2018 school year for 6th Grade only. To qualify for the
Christiana Middle School Honors Academy, each student must (by January 11, 2017):
 Complete all sections of the Student Application
 If you are applying from outside the Christina School District as a Choice student, you must
submit:
o The most recent report card for the academic years 2015-2016 (4th grade) and 20162017 (1st grading period from 5th grade)
o State Standardized Test Scores (2015-2016 Smarter Balanced Reading and Math, and
other applicable standardized tests, such as NWEA or STAR)
 Current Christina School District Students do not need to provide report cards and test scores,
as these will be obtained through District data sources
 Submit two (2) teacher recommendations
 Submit a written description of extra-curricular activities. Please include in/out of school
enrichment activities
 Complete the Parent Statement Form
 Schedule an appointment to take the placement exam. The placement exam (approximately 1
hour) consists of:
o an English Language Arts performance task
o a Math Problem Solving performance task
 Complete and submit a School Choice form. Regardless of your middle school feeder pattern,
you must apply for School Choice and indicate the Christiana Middle School Honors Academy as
the choice program. School Choice applications are available on the District website and at
every school beginning November 7, 2016. School Choice applications must be submitted to the
District Choice Office by 4 p.m. on January 11, 2017.
After a review of the completed application packet and placement exam scores, students will receive
written notification through the mail, indicating their status in regard to acceptance into the program.
The anticipated number of available seats is 125 for year one.
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 3 of 14

STUDENT APPLICATION
(To be completed in Grade 5)

Deadline: Submitted by January 11, 2017
(2017- 2018 school year)

Date of Application

Student’s Current Grade Level

Student Information
Last Name:

First:

MI:

Street Address:

City:

State:

Home Phone:

Current School and District:

Student ID #:

Date of Birth:

Zip:

Gender:

□ Male

□ Female

Race:

□ American Indian/Alaska Native

□ Black/African American

□ White/Caucasian

□ Native Hawaiian/Other Pacific Islander

□ Hispanic/Latino

□ Multi-racial

□ Asian American

Current Feeder High School

Additional Student Information:

Indicate performing arts interest: Band ____ Choral ____ Art____

Indicate World Language Interest: Spanish____ French_____

Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 4 of 14

Continued-Page 2-STUDENT APPLICATION

Student’s Name: _________________________________________________________________________
Last

First

MI

Parent A/Guardian A/Caregiver A:
(Please check which telephone number is your preferred method of contact)
Last Name:

First:

MI:

Street Address:

City:

State:

Zip:

□ Home Phone:

□ Work Phone

□ Cell Phone

Email address:

Parent B/Guardian B/Caregiver B:
(Please check which telephone number is your preferred method of contact)
Last Name:

First:

MI:

Street Address:

City:

State:

Zip:

□ Home Phone:

□ Work Phone

□ Cell Phone

Email address:

_________________________________________
Student’s Signature

Date

_________________________________________
Parent/Guardian’s Signature

Date

Return completed application and required documents to: Christiana Middle School Honors Academy,
Attn: Office of the Assistant Superintendent, 600 North Lombard Street, Wilmington, DE 19801
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 5 of 14

TEACHER RECOMMENDATION FORM
This form is confidential. Teachers, please submit in sealed envelope to address on the bottom of
page 2 of teacher recommendation form. Do not return to the student. Use district or state mail.

Student’s Name: _________________________________________________________________________
Last

First

Student’s School: _________________________

MI

Grade Level You Have Taught Student: _____

To Teacher(s): Use the following rating scale to describe the student’s learning characteristics and levels of
motivation and creativity. Also, please provide comments you feel may be helpful to our selection process. Your
time and professional judgment in completing this form is greatly appreciated.

5 - Outstanding

4 - Excellent
3 - Good
2 - Average
Place a mark (X) in the appropriate box.

1 - Below Average

5

4

3

2

1

I. Learning Characteristics
Learns quickly and retains information
Demonstrates interest and curiosity about a wide range of topics
Possesses good oral and written communication skills
Follows routines, procedures, and directions
II. Motivation
Demonstrates an ability to work independently
Demonstrates an ability to collaborate with others
Shows
a high levelemotionally
of self-motivation
Is
self-confident,
secure, and self-assertive
Manages time well
Possesses organizational skills
Shows excitement and enthusiasm for learning
Completes class work, homework, and special projects on time
Demonstrates persistence when faced with challenges
III. Creativity
Generates novel or unusual ideas
Creates unique solutions to problems
Recognizes and appreciates connections
Is an independent thinker
Total Points
(continues)
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 6 of 14

Continued-Page 2-TEACHER RECOMMENDATION FORM

Student’s Name: ________________________________________________________________
Last

First

MI

In the box below, please provide comments you feel may be helpful to our selection process.

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

__________________________________
Teacher’s Name (Print)

_____________________________

____________

Teacher’s Signature

Date

Please place a mark (X) indicating your overall recommendation for the student based on the point total from
page 1.
_____Highly Recommend (80-71 points)
_____Recommend (70-61 points)
_____Recommend with Reservation (60-51 points)
_____Cannot Recommend (50 and below)

This form is confidential
Please return this form in a sealed envelope to:
Christiana Middle School Honors Academy
Attn: Office of the Assistant Superintendent
600 North Lombard Street, Wilmington, DE 19801
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 7 of 14

TEACHER RECOMMENDATION FORM
This form is confidential. Teachers, please submit in sealed envelope to address on the bottom of
page 2 of teacher recommendation form. Do not return to the student. Use district or state mail.

Student’s Name: _________________________________________________________________________
Last

First

Student’s School: _________________________

MI

Grade Level You Have Taught Student: _____

To Teacher(s): Use the following rating scale to describe the student’s learning characteristics and levels of
motivation and creativity. Also, please provide comments you feel may be helpful to our selection process. Your
time and professional judgment in completing this form is greatly appreciated.

5 - Outstanding

4 - Excellent
3 - Good
2 - Average
Place a mark (X) in the appropriate box.

1 - Below Average

5

4

3

2

1

I. Learning Characteristics
Learns quickly and retains information
Demonstrates interest and curiosity about a wide range of topics
Possesses good oral and written communication skills
Follows routines, procedures, and directions
II. Motivation
Demonstrates an ability to work independently
Demonstrates an ability to collaborate with others
Shows
a high levelemotionally
of self-motivation
Is
self-confident,
secure, and self-assertive
Manages time well
Possesses organizational skills
Shows excitement and enthusiasm for learning
Completes class work, homework, and special projects on time
Demonstrates persistence when faced with challenges
III. Creativity
Generates novel or unusual ideas
Creates unique solutions to problems
Recognizes and appreciates connections
Is an independent thinker
Total Points
(continues)
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 8 of 14

Continued-Page 2-TEACHER RECOMMENDATION FORM

Student’s Name: ________________________________________________________________
Last

First

MI

In the box below, please provide comments you feel may be helpful to our selection process.

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

__________________________________
Teacher’s Name (Print)

_____________________________

____________

Teacher’s Signature

Date

Please place a mark (X) indicating your overall recommendation for the student based on the point total from
page 1.
_____Highly Recommend (80-71 points)
_____Recommend (70-61 points)
_____Recommend with Reservation (60-51 points)
_____Cannot Recommend (50 and below)

This form is confidential
Please return this form in a sealed envelope to:
Christiana Middle School Honors Academy
Attn: Office of the Assistant Superintendent
600 North Lombard Street, Wilmington, DE 19801
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 9 of 14

EXTRA-CURRICULAR ACTIVITIES FORM
In the space provided below, please provide a list of extra-curricular activities you have
participated in both in/out of school. Provide a description of the activity if necessary.

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Did you participate in the Advanced Academic Program (AAP) in elementary?
_____Yes _____No
___________________________________________________________________________________
__________________________________________________________

Student’s Name: ________________________________________________________________
Last

First

MI

Return completed application and required documents to: Christiana Middle School Honors Academy,
Attn: Office of the Assistant Superintendent, 600 North Lombard Street, Wilmington, DE 19801

Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 10 of 14

PARENT STATEMENT FORM
In the space below, please provide a written statement describing why you are requesting admission to
the Christiana Middle School Honors Academy. Why and how will this learning environment benefit your child?

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________
Student’s Name: ________________________________________________________________
Last

First

MI

Return completed application and required documents to: Christiana Middle School Honors Academy,
Attn: Office of the Assistant Superintendent, 600 North Lombard Street, Wilmington, DE 19801

Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 11 of 14

ADMISSIONS RUBRIC
4th Grade Report Card (3rd Trimester/Final Marking Period)
Math
16 points
Reading
8 points
Writing
4 points
th
st
5 Grade Report Card (1 Trimester Grades)
Math
16 points
Reading
8 points
Writing
4 points
Standardized Test Scores
Standardized State Test Scores –
20 points
Smarter Balanced – ELA (4th Grade)
Standardized State Test Scores –
20 points
Smarter Balanced – Math (4th Grade)
Placement Exams
Placement Exam English Language
20 Points
Arts Performance Task
Placement Exam Math
20 Points

10%
5%
2.5%
10%
5%
2.5%
12.5%
12.5%

12.5%
12.5%

Teacher Recommendations
Extra-Curricular Activities

20 points
4 points

12.5%
2.5%

Total

160 Points

100%

Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 12 of 14

4th Grade Report Card Final Semester and 5th Grade Report Card First Semester
28-point maximum for each report card
Math (x3)
Reading (x2)
Writing (x1)
Each EP = 4 points
Each EP = 4 points
Each EP = 4 points
Each MP = 3 points
Each MP = 3 points
Each MP = 3 points
Each NP = 2 points
Each NP = 2 points
Each NP = 2 points
Total Points = 16
Total Points = 8
Total Points= 4

Teacher Recommendation Point Value for Each – 20 points maximum
Highly Recommend
10 points
Recommend
8 points
Recommend with Reservation
6 points
Cannot Recommend
4 points

Extra-Curricular Activities – 2 points maximum
Form has at least one activity listed
2 points
Form does not have an activity listed
0 points

Standardized State Test Scores (Smarter Balanced) English Language Arts
Score of 4 Exceeded the Standard
20
Score of 3 Met the Standard
15
Score of 2 Nearly Met the Standard
10
Score of 1 Below the Standard
5

Standardized State Test Scores (Smarter Balanced) Math
Score of 4 Exceeded the Standard
20
Score of 3 Met the Standard
15
Score of 2 Nearly Met the Standard
10
Score of 1 Below the Standard
5

Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 13 of 14

APPLICATION CHECK LIST
All Applicants Must Complete the Following:
 Christiana Middle School Honors Academy Application
 Teacher Recommendation #1 (Please note: Teachers will return form directly to school.)
 Teacher Recommendation #2 (Please note: Teachers will return form directly to school.)
 Extra-curricular Activities Form
 Parent Statement Form
 Submit School Choice Form
 Schedule Placement Exams Appointment
 English Language Arts Performance Task
 Math Problem Solving Performance Task
Additional Requirements for Delaware Students Applying from Outside the
Christina School District as a Choice Student:
 4th Grade Report Card – 2015-2016 school year
 5th Grade Report Card – 2016-2017 1st grading period
 State Standardized Test Scores
 2015-2016 Smarter Balanced Reading and Math
 Other applicable Standardized Tests (NEWA, STAR, etc.)
Return Completed Application and Required Documents to:
Christiana Middle School Honors Academy
Attn: Office of the Assistant Superintendent
600 North Lombard Street, Wilmington, DE 19801
Please note: Current Christina School District Students do not need to provide report
cards and test scores, as these will be obtained through District data sources.

SUBMISSION DEADLINE: January 11, 2017
Questions? Contact the Office of the Assistant Superintendent at (302) 552-2739
Applications will not be processed until all required information is received.
Page 14 of 14

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