APPLICATION FOR THE HEALTH CAREERS ACADEMY

9TH GRADE ACADEMIC CORE- 2015-2016

(Please print or type clearly)
The Health Careers Academy continually seeks to find committed individuals who
have made a personal decision to explore the health care field.
I am interested in being a part of the Health Careers Academy at Palmdale High
School
STUDENTS NAME ________________________________________________
HOME ADDRESS_____________________HOME PHONE ________________
CITY____________________ STATE__________ZIP _____________________
PRESENT SCHOOL________________________________________________
Please return this application to Palmdale High School attn: Mr. Klein or
Mrs. Hefter Health Careers Academy
1. AT THE PRESENT TIME, WHAT ARE YOUR EDUCATIONAL GOALS?

2. AT THE PRESENT TIME, WHAT ARE YOUR CAREER GOALS?

3. HOW WILL THE HEALTH CAREERS ACADEMY HELP YOU MEET YOUR
EDUCATIONAL AND CAREER GOALS?

4. PLEASE LIST EXAMPLES CONCERNING HOW YOU HAVE PREPARED

YOURSELF FOR A CAREER IN THE HEALTH CARE FIELD THUS FAR.
(1)

5. ACTIVITIES- list any clubs, sports or other organizations with which you have
been involved with in or out of school. (Possibilities include Scouting, church
groups, or community service organizations.)

6. INTERESTS- List three things that you like to do in your spare time. In other
words, tell us a bit about yourself.

7. CURRENT SCHEDULE- What classes are you currently enrolled in and what
grades do you think you are receiving in those courses? What courses do you
hope to take next year?

THE ENTIRE APPLICATION MUST BE FILLED OUT BEFORE REVIEW.

EACH APPLICATION MUST HAVE A COMPLETED RECOMMENDATION
FORM, FILLED OUT BY A FORMER OR CURRENT TEACHER, SEALED IN
AN ENVELOPE AND ATTACHED TO THIS APPLICATION.
My signature below indicates that I give my consent to my son/daughter to
register for the Health Careers Academy at Palmdale High School.
_____________________________________DATE_______________
PARENTS/ GUARDIANS SIGNATURE

(2)

RECOMMENDATION FORM
PALMDALE HIGH SCHOOL HEALTH CAREERS ACADEMY
2015-2016

STUDENT NAME ______________________________________

SCHOOL _____________________________________________
Dear Teacher/Counselor/Employer:
This student is applying for the Health Careers Academy Academic Core
Program. Please complete the student rating form and make any comments in
the space provided.
Please return this form SEALED IN AN ENVELOPE to the student as soon as
possible. Thank you in advance for your service to this student. Your opinion is of
great value to us.
1. DAILY ATTENDANCE IS:
EXCELLENT
(0-2 absences)

GOOD
(3-4 abs.)

FAIR
(5-8)

POOR
(frequent)

2. ON TIME TO BEGIN CLASS or WORK IS :

Always

Most of the time

Sometimes Seldom

3. COMPLETION OF PROJECTS/ JOBS ON TIME IS:

Always

Most of the time

Sometimes Seldom

4. PARTICIPATION AND INTEREST IN ACTIVITIES/JOB IS:

High

Very Good

(3)

Good

Fair

5. Because the spaces available to students are limited, it is important that

those selected have a commitment to complete the coursework. This
means that the student needs to be at school everyday, on time and with
completed assignments. Based on your information, how would you
recommend this student:
HIGHLY__________________

RECOMMENDED________________

RECOMMENDED WITH RESERVATIONS______________________

6. ADDITIONAL COMMENTS:

Reference Name: ___________________________

Signature: _________________________________
School Organization: ____________________________
Date: ________________ Phone and Extension: _______________________

(4)

APPLICATION FOR THE HEALTH CAREERS ACADEMY

10TH GRADE ACADEMIC CORE- 2015-2016
NAME ___________________________SCHOOL _________________
STUDENT ID #______________CURRENT GRADE LEVEL _________
BIRTH DATE __________ ADDRESS ___________________________
HOME PHONE ___________________WORK PHONE ______________
PARENT/GUARDIANS NAME _________________________________
PLEASE RETURN THIS APPLICATION TO MR. KLEIN IN RM. 333 OR MRS.
HEFTER IN RM 383. If you were not in the Health Careers Academy as a
Freshman and are applying for the first time, you will also need to schedule
an interview with Mr. Klein. Please come by room 333 to make an
appointment to schedule an interview time. The application is due by March
2, 2015.
Please answer the following questions. Attach a separate sheet of paper if you
need additional room to answer any of the questions.
1. Why do you want to continue taking Health Careers Academy courses?
Please Note: If this is your first year to apply for the Academy, please write
why you would like to enroll in the Health Careers Academy.

2. What have you accomplished in the last year that demonstrates your
interest in the health care field?

3. What are your plans for your life after graduating high school?

4. Please list examples concerning how you are preparing yourself for a
career in medicine.

5. ACTIVITIES- list any clubs, sports or other organizations with which you have
been involved with in or out of school. (Possibilities include Scouting, church
groups, or community service organizations.)

6. INTERESTS- List three things that you like to do in your spare time. In other
words, tell us a bit about yourself.

7. CURRENT SCHEDULE- What classes are you currently enrolled in and what
grades do you think you are receiving in those courses? What courses do you
hope to take next year?

THE ENTIRE APPLICATION MUST BE FILLED OUT BEFORE REVIEW.

EACH APPLICATION MUST HAVE A COMPLETED RECOMMENDATION
FORM, FILLED OUT BY A FORMER OR CURRENT TEACHER, SEALED IN
AN ENVELOPE AND ATTACHED TO THIS APPLICATION.
My signature below indicates that I give my consent to my son/daughter to
register for the Health Careers Academy at Palmdale High School.
_____________________________________DATE_______________
PARENTS/ GUARDIANS SIGNATURE

RECOMMENDATION FORM
PALMDALE HIGH SCHOOL HEALTH CAREERS ACADEMY
2015-2016
STUDENT NAME ______________________________________
SCHOOL _____________________________________________
Dear Teacher/Counselor/Employer:
This student is applying for the Health Careers Academy Academic Core Program. Please
complete the student rating form and make any comments in the space provided.
1. DAILY ATTENDANCE IS:
EXCELLENT
(0-2 absences)

GOOD
(3-4 abs.)

FAIR
(5-8)

POOR
(frequent)

2. ON TIME TO BEGIN CLASS or WORK IS:

Always

Most of the time Sometimes

Seldom

3. COMPLETION OF PROJECTS/ JOBS ON TIME IS:

Always

Most of the time Sometimes

Seldom

4. PARTICIPATION AND INTEREST IN ACTIVITIES/JOB IS:

High

Very Good

Good

Fair

5. Because the spaces available to students are limited, it is important that those selected
have a commitment to complete the coursework. This means that the student needs to be
at school everyday, on time and with completed assignments. Based on your information,
how would you recommend this student:
HIGHLY__________________

RECOMMENDED________________

RECOMMENDED WITH RESERVATIONS______________________

6. ADDITIONAL COMMENTS:

Reference Name: ___________________________

Signature: _________________________________
School Organization: ____________________________
Date: ________________ Phone and Extension: _______________________