ETIP Summer Experience 2023 Supplemental Application

ETIP Summer Experience Application Instructions

Based on your student’s ETIP application, we would like to invite your student to submit further documentation in order to gain full acceptance to the ETIP Summer 2023 Cohort!

Please read the instructions below carefully. If you have any further questions, please email: etip@pqc.edu.

The information below is intended to evaluate candidates’ readiness & value alignment to the ETIP program. Please obtain the following documentation prior to beginning the application:

Student Medical Information
Student Proof of Covid-19 Vaccination
Most Recent School Grade Report or Transcript
Most Recent Standardized Test Report, Gr 4-8 (STAAR, NWEA MAP ISEE, ITBS)
Student Writing Samples.
Teacher & Principal Names & Email Address (for a student recommendation)
Enrollment Confirmation & Registration Information

Parent & Student Information

Child Resides with...*

Parent 1 Name*

First Last

Parent 1 Primary Phone*

Parent 1 Email*

Student's Full Name*

First Last

Gender*

Student's Grade Level (as of 08/01/2023)*

Student Shirt Size*

Home Address*

Street Address Address Line 2 City State ZIP Code

Student Race*

Student Ethnicity*

If applicable, complete Parent 2 information

Parent 2 Name

First Last

Parent 2 Primary Phone

Parent 2 Email

Student Medical Information

Insurance Carrier*

Policy Holder*

Policy Number*

Pediatrician/Physician Name*

Pediatrician/Physician Number*

Has the student received the Covid-19 Vaccine?*

Please note: Evidence of Covid-19 Vaccination must be submitted by June 1, 2023 in order to be considered for the ETIP Program

Covid-19 Vaccination Card Upload*

Please Upload the Front/Back Copy of Your Student’s Covid-19 Vaccination Card

Drop files here or

Max. file size: 50 MB.

Does this student have any additional medical conditions or take any over the counter or prescription medication?*

If yes, please provide details:*

Student Academic Information

Please upload the student’s most recent grade report for the 2022 - 2023 school year.*

Drop files here or

Max. file size: 50 MB.

Please upload the student’s 2021-2022 STAAR Test results and/or their most recent standardized test score results.*

If the student is entering PK – Grades 4 as of August 2023 and has not yet completed the STAAR, please upload a homework assignment that best reflects the student’s most recent Mathematics and Language Arts skills (or their most recent standardized test score results). (STAAR, NWEA MAP ISEE, ITBS, etc)

Drop files here or

Max. file size: 50 MB.

Student Picture

Please upload your student’s latest school or professional headshot.*

Please upload your student’s latest school or professional headshot.

Drop files here or

Max. file size: 50 MB.

Student Writing Sample

Note: If the student is entering Pre-Kindergarten, Kindergarten or Grade 1 as of August 1, 2023, the writing section is not required.

The writing sample should be written in the student’s own handwriting and should answer the prompt below depending on the respective grade level.

Review the assigned ETIP Writing Prompts by clicking here.
Review the ETIP Writing Rubric to evaluate your writing by going here.
Review the ETIP Values to accurately incorporate examples and definitions by going here.

Student Writing Upload

Please upload a student writing sample.

Drop files here or

Max. file size: 50 MB.

Principal & Teacher Recommendation

At least one teacher must complete the recommendation form on behalf of the applicant for full acceptance into the ETIP 2023 program.

Please complete the recommender information below:

Recommender Name*

Recommender Title*

Recommender's School*

Recommender's Email*

ETIP Enrollment

Please select your student’s enrollment/participation dates:*

Full ETIP Program: June 19th – June 30th, July 10th – 21st and July 24th – 28th: $920

Session I: June 19th – June 30th: $360 (2-weeks of programming)

Session II: July 10th – July 21st: $360 (2-weeks of programming)

Session III: July 24th-28th: $200

Additional Payment Information:

Upon full program acceptance tuition instructions will be provided.
Families may opt to pay per-session tuition amounts. Tuition is due 5 business days prior to the start of each session.
A limited amount of Academic Performance Scholarships & Financial Aid Scholarships will be provided on a case-by-case basis.

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