Georgia Military College Prep School

2012 –2013

Application for Admission

201 East Greene Street Milledgeville, GA 31061 Telephone: (478) 387-4878

Fax (478) 445-4536

Web Address: http://www.gmc.cc.ga.us/prep_school Prep School Motto:

“Develop the intellect; elevate the character.”

Milledgeville

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Campus Map June, 2010

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City Parking 15

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Greene Street

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Staff & Faculty

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Visitor & Commuter Only

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5

Tennis Courts

Water Tower

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24 (HS Cadet Parking)

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Staff & Faculty

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(JC Cadet Parking)

Franklin Street

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25 Softball Field Concession Stand

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LEGEND: 1. Old Capitol Building 2. Grant Parade 3. New Academic Building II 4. Zell Miller Hall 5. Miller Hall Parking Lot 6. Usery Hall (Prep School) 7. Library 8. Jenkins Hall (MSD) 9. Wilder Hall (IT) 10. Patton Hall 11. Davenport Field 12. Parham Hall (Business Affairs) 13. Admissions

14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Advancement Engineering Shipping/Receiving Soccer Field Nash House Tennis Courts Cordell Events Center Jackson Hall House (HR) Baugh Barracks To: LRC/Rappel/Football Fields Ruark Athletic Center Craig Field (Baseball) P Parking AED Locations Call Boxes

Prep School – Office of the Principal 201 East Greene Street │ Milledgeville, GA 31061 (478) 387-4878 │ (478) 445-4536 fax │ www.gmc.cc.ga.us/prep_school

Dear Parent(s), Thank you for your interest in Georgia Military College Prep School. Since our establishment in 1879 by the Georgia General Assembly, GMC’s mission has been to produce educated, contributing citizens. We accomplish this by providing our cadets an inclusive college-preparatory curriculum in an environment conducive to the development of the intellect and the elevation of character. The information included in this packet will provide you and your child with an overview of what GMC Prep School has to offer. Once you have reviewed this information, please feel free to contact me about campus tours, our shadowing programs, or simply to answer any questions you may have.

COL John Thornton GMC Prep School Principal (478) 387-4878 [email protected]

Academic Curriculum SY 2012-2013

6th – 8th Grade Curriculum 6th Grade:

7th Grade:

English 6 or Advanced Eng 6 Math 6 or Accelerated Math 6 Earth Science Social Studies P.E. / Health Exploratory* Enrichment**

English 7 or Advanced Eng 7 Math 7 or Accelerated Math 7 Life Science Social Studies P.E. / Health Exploratory* Enrichment**

8th Grade: English 8 or Advanced Eng 8 Math 8 or High School Math I Physical Science Georgia History P.E. / Health Exploratory* Enrichment**

Students qualify for the Accelerated Math and/or Advanced English programs based on grades and standardized test scores in the areas of math and language arts. Records are reviewed during the application process and parents of eligible students are contacted. *Exploratory classes meet every day for either a nine or eighteen week period. Classes vary by grade and include Band, Leadership, Computers, and Musical Theatre. **Enrichment classes meet two days per week for a nine-week period. Classes vary by grade and include Character Development, Current Events, Etiquette, Odyssey of the Mind, and Public Speaking.

High School Curriculum English - 4 Units

Math – 4 Units

Science – 4 Units

English I or Advanced Eng I English II or Advanced Eng II English III or AP Language English IV

Math I or Accelerated Math I (*required) Math II or Accelerated Math II (*required) Math III or Accelerated Math III (*required) Math IV AP Calculus AP Statistics

Physical Science Biology I (*required) Chemistry (*required) AP Biology Human Anatomy Physics

Social Studies – 4 Units

Foreign Language

JROTC – 4 Units

World History American History or AP US History Economics American Government

(2 Consecutive Units) Spanish I and Spanish II OR French I and French II

LET I LET II LET III LET IV

Fine Arts - 1 Unit

Health / P.E.

Computer Applications (1/2 unit) Music Appreciation (1/2 unit)

Health (1/2 unit) Physical Education (1/2 unit)

Our Advanced Placement (AP) program is certified by the Collegeboard. Students qualify for the Accelerated Math and/or Advanced English programs based on grades and standardized test scores in the areas of math and language arts. Records are reviewed during the application process and parents of eligible students are contacted. Qualified GMC Prep School Seniors may choose to participate in the Dual Enrollment (ACCEL) program by enrolling in college courses offered through GMC Junior College. The cost for the DE program is covered by Georgia’s HOPE scholarship plan.

Revised 11/28/2011

GMC Prep School SY 2012-2013

Admissions Criteria To be accepted as a student at GMC Prep School all candidates for admission must submit an application that is reviewed by the Admissions Committee. Admission may be granted to those applicants with acceptable overall grade point averages, standardized test scores, successful promotion of previous grades based on passage of CRCT or comparable test, and discipline records. Potential candidates who have been administratively placed in a grade level will not be considered for admission. The applicant’s complete academic and discipline record will be evaluated. The Admissions Committee requires the following documents before a student may be considered for complete acceptance to Georgia Military College Prep School: 1.

A non-refundable Application Fee of $30.00 must accompany a completed 2012-2013 application.

2.

An Official Transcript to include, but not limited to, all previous courses, grades and credits, test scores, CRCTscores, student support services records, and discipline history of the prospective student in all the previous schools attended up through the date of last attendance. Submit the enclosed “Request for Student Records” form to your child’s school to have the transcript sent.

3. 4. 5.

A completed GMC Student Information Sheet. An up-to-date completed GMC Physical Examination, Medical History & Clearance Form. An up-to-date GMC Medical Release Form.

6.

An up-to-date copy of the prospective student’s Certificate of Eye, Ear and Dental Examination, Georgia Department of Human Resources Form #3300.***(This is a document required by the State of Georgia and may be obtained from your child’s physician,

your local health department or GMC Health Services.)

7.

An up-to-date copy of the prospective student’s Certificate of Immunization, Georgia Department of Human Resources Form #3231. .***(This is a document required by the State of Georgia and may be obtained from your child’s physician, your local health department

or GMC Health Services through the Georgia Immunization Registry.)

8. 9. 10.

A copy of the prospective student’s Birth Certificate. A copy of the prospective student’s Social Security Card. A signed Computer Acceptable Use and Ethics Policy Waiver.

11. 12.

A copy of Court Orders related to child custody, adoption, etc. Any other documentation requested by the Admissions Committee.

Tentatively Accept The Admissions Committee will review the documentation and decide whether or not your child is accepted to GMC Prep School. The Admissions Committee may tentatively accept a student, providing that the applicant’s overall grade point averages, standardized test scores, and discipline records are acceptable. To be tentatively accepted the following information must be submitted: 1.

A non-refundable Application Fee of $30.00 must accompany a completed current application.

2.

An Official Transcript to include, but not limited to, all previous courses, grades and credits, test scores, CRCT scores, student support services records, and discipline history of the prospective student in all the previous schools attended up through the date of last attendance. Submit the enclosed “Request for Student Records” form to your child’s school to have the transcript sent.

3.

A completed GMC Student Information Sheet.

Georgia Military College Prep School values diversity and provides an inclusive and welcoming environment for many in the GMC Community. The Admissions Committee seeks to select a talented and diverse student body, taking into account a variety of factors, including the applicant's academic record and discipline history. Georgia Military College Prep School is committed to nondiscrimination and equal opportunities in its admissions, educational programs, and activities regardless of race, color, creed, religion, gender, sexual orientation, national origin, ancestry, age, and disability. Georgia Military College Prep School is currently accredited by the Southern Association of Colleges & Schools (SACS) and has been since 1928. Georgia Military Prep School reserves the right not to accept any prospective student who has been expelled, terminated, suspended, and/or separated from another school.

Completed application, accompanying paperwork, and application fee should be submitted to the Prep School’s Admissions Committee via the GMC Prep School Principal’s Office located in Usery Hall (Grant Parade Entrance) or mailed to GMC Prep School – Principal’s Office 201 East Greene Street Milledgeville, GA 31061

SY 2012-13 GMC Prep School Application for Admission (A Non-Refundable Application Fee of $30.00 is required at the time of application.)

Date Applicant Plans To Enter GMC: ____/___/___ Soc. Sec# _______-_____-_______

Date of Birth M____/D____/Y______

Entry Grade (Circle) 6 7 8 9 10 11 12

O Female

O Male

Last Name _____________________ First Name __________________ Middle Name _______________ Goes By: _________________ For School Use Only

Current Address: ________________________________________________________________________

****************** Application Rec'd:

City: ____________________________ State _______________ Zip Code ________________

_____________________

Mailing Address (If different from above):

Pd. $30 Application Fee_______________ Waived -Reason: ____________________

__________________________________________________________________

Method of Payment: Cash – To ADM ___________

City: ____________________________ State _______________ Zip Code _______________ Home Telephone Number (____) ____________________ Student’s Cell Number (____) __________________ U.S. Citizen: ___Yes ___No

Check # _____________ Other _____________#____________

County of Residence: ________________________ If Baldwin County: Do you live __INSIDE City of Milledgeville or __OUTSIDE City of Milledgeville? Ethnic Origin: ___Caucasian

___African American

Student Lives With: __ Parents Legal Guardian(s): __ Parents

___Hispanic

___Mother ___ Mother

___Am. Indian/Alaska Native

___Father ___Father

___Asian/Pacific Islander

__Grandparent(s) __Grandparent(s)

___Other: ________________

__ Other: ______________________________ __ Other: ______________________________

Legal Father’s Name Address

______________________________________________________ ______________________________________________________

City, State, Zip Occupation

______________________________________________________ _____________________________________ Place of Employment _____________________________________

Telephone

Work ___________________

Legal Mother’s Name

Email Address _____________________________________________________ ______________________________________________________

Address City, State, Zip Occupation

______________________________________________________ ______________________________________________________ _____________________________________ Place of Employment _____________________________________

Telephone

Work ___________________

Home____________________

Home____________________

Cell_______________________

Cell_______________________

Email Address _____________________________________________________ Legal Guardian/ Step-Parent’s Name

______________________________________________________

Address City, State, Zip Occupation

______________________________________________________ ______________________________________________________ _____________________________________ Place of Employment _____________________________________

Telephone

Work ___________________

Home____________________

Cell_______________________

Email Address _____________________________________________________

Sibling(s) Who Will Attend GMC Prep School For The 2012-13 School Year: Sibling’s Name_______________________________ Grade:______

Sibling’s Name____________________________ Grade: ______

Sibling’s Name________________________________ Grade:______

Sibling’s Name____________________________ Grade: ______

Name and address of each school applicant has attended during the past three years: Year _____ Grade ____ School ___________________________ Address: ________________________________________ Year _____ Grade ____ School ___________________________ Address: ________________________________________ Year _____ Grade ____ School ___________________________ Address: ________________________________________ Is the applicant in good standing with the school last attended? _____ Would he/she be eligible to return to the last school attended during the grading period of desired entry to GMC? _______________ Has the applicant ever been expelled from school? _____ If so, please explain: _____________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Has the applicant ever been suspended from school? _____ If so, how many times? _____ Please explain the circumstances: ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Has the applicant ever been assigned in school suspension (ISS)? _____ If so, how many times? _____ Please explain: ____________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Has the applicant ever been assigned to an alternative school? _____ If so, please explain:____________________________________ ______________________________________________________________________________________________________________ Has the applicant been enrolled in the following: (Please check yes or no for each category) Honors: O Yes O No Gifted: O Yes O No Accelerated: O Yes O No AP Classes: O Yes O No Special Education: O Yes O No Remedial Classes: O Yes O No Does the applicant have an IEP or 504 completed by the Program for Exceptional Children or has one been recommended? _____ If so, a copy must be included with the application or enclosed in the applicant’s transcripts. Has the applicant ever failed any parts of the CRCT or comparable testing used for promotional criterion? _____ If so, please explain: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Please list any reason that the applicant may not be able to fully participate in physical training, JROTC, drill and parade, cardiovascular and strength training, or other strenuous exercise: __________________________________________________________________________ _______________________________________________________________________________________________________________ Has the applicant ever been involved with the police or counseled by juvenile authorities? _______________________________________ _______________________________________________________________________________________________________________ Has the applicant ever had a drug or alcohol problem? _____ If so, please explain: ___________________________________________ _______________________________________________________________________________________________________________ List any honors, special awards (academic or service oriented) the applicant has received. _______________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ I certify that the applicant is of good character and amenable to discipline, that he/she desires to attend Georgia Military College and that he/she agrees to abide by the rules and regulations of the school. I understand that this application, the physical form and medical consent form, the required immunization records, the transcripts and the other supporting academic records, and all explanations and supporting data relative to the preceding must be at Georgia Military College prior to the first day of school. I understand that the school may accept this contract based upon the information submitted on the application for admission. If any information in the application is false, misleading, or omitted, which in the opinion of the school would reflect adversely on the decision for acceptance, the school may dismiss the student or I may withdraw the student. The refund policy is outlined in the information booklet, and is understood by each party. I authorize GMC school officials to verify any of the above information with any or all agencies (medical, legal, law enforcement, academic, etc.) as needed in order to process this application.

Date ___________________

Parent/Guardian Signature ___________________________________________________

1.0 Overview

Georgia Military College Computer Acceptable Use and Ethics Policy

This document details the Acceptable Use and Ethics which covers the proper utilization of the computers, networks and related services at Georgia Military College. This policy has been developed to ensure a quality computing environment at GMC that furthers the academic, and service mission of the institution. Providing this environment requires equitable resource distribution, computer and network availability, personal privacy, and data integrity. Achieving this goal requires that everyone in the College community cooperate and adhere to these guidelines. This policy has been developed by members of the Office of Information Technology, in conjunction with the Information Technology Committee and the Executive Vice President. Computers are used to support learning and to enhance instruction. Computer networks allow people to interact with many computers. The Internet allows people to interact with hundreds of thousands of networks. It is a general policy that all computers are to be used in a responsible, efficient, ethical and legal manner. Failure to adhere to the policy and the guidelines below will result in the revocation of the users’ access privilege by the network administrator. 2.0 Authorized Users

Individuals who have been granted and hold an active and authorized account on a GMC computer or network and abide by this policy are considered authorized users. 3.0 Authorized Use

Authorized use is predicated on access by an authorized user. Authorized use is that which is consistent with the academic, research, and service goals of this institution and falls within the guidelines of this policy which states that property owned by the institution shall be used only for institutional purposes. Unacceptable uses of the computer include : 1. Using profanity, obscenity, other language which may be offensive to another user. 2. Reporting (forwarding) personal communication without the author’s prior consent. 3. Coping commercial software in violation of copyright law. 4. Using the network for financial gain, for commercial activity or for any illegal activity. 4.0 Individual Rights 4.1 Privacy

The computing professionals at GMC are committed to preserving the privacy of each authorized user of the computer system and make every effort to ensure that computers and electronic devices are not used to prevent this. However, it is impossible to guarantee such privacy and there are several specific issues that users must be aware of. Electronic mail messages are not secure and, therefore, should not be assumed to be private. Also, despite best efforts to prevent it, a determined person could gain unauthorized access to stored data and thus violate your privacy. Under the Georgia Open Records law it is possible that information which is stored on a computer system, including electronic mail, would be available for inspection by any member of the public. Finally, in the process of performing normal systems/network management and auditing functions, it may be necessary to view user’s files or confidential information. However, system network, and application administrators are bound by both professional ethics as well as job requirements to respect the privacy of those involved and not initiate disclosure of information obtained in this manner. 4.2 Freedom of Expression

Freedom of expression is a constitutional right afforded to all members of the community and existing Institution policies apply equally to computerized expression, subject to Section 3.0 of this policy. GMC computer and network users should realize that there are services available on the Internet which may be considered offensive to some. With this in mind, users take responsibility for their navigation of the network. 4.3 Safety and Freedom from Harassment

While GMC cannot control Harassment or unsolicited contact on the network, those who believe they have been harassed should follow standard College procedures in reporting such violations. 5.0 Individual Responsibilities

Users of GMC computer equipment are expected to understand this policy and abide by it. This policy is widely distributed and easily accessible, so lack of knowledge of this policy is not an excuse for failure to observe it. Questions regarding this policy can be directed to the Vice President of Information Technology, or the Executive Vice President. Disregard for this policy may result in disciplinary actions as set forth in Section 6.0 of this document. 5.1 Morals and Ethics

Users are expected to respect the right to privacy of other individuals on the network. Do not go browsing around in someone’s files even if security permissions permit. This is analogous to condoning someone rifling around on your desk or in your house simply because you forgot to lock your door. It is expected that explicit permission from the owner of the files is obtained before they are accessed. Users are expected to respect the right of freedom of expression of others on the network. 5.2 Expected Behaviors

This section details some guidelines relating to computer based activities. GMC computer users are expected to read sign on messages and system news for specific information such as system changes, policies, and scheduled down time. System and network administrators may

find it necessary to contact you regarding policy issues. If repeated attempts to contact a student are unsuccessful, the system or network administrator may be forced to temporarily deactivate the student’s account simply to compel the owner to make contact. 5.2.1 User Identification (Userids) and Passwords

It is a violation of policy to use a computer userid (or any computer resource) that is not assigned to you or to share userid passwords with other individuals (including computing personnel). A computer userid is granted to an individual and that individual is responsible for any use of the account. If your userid or password is compromised, you must immediately notify the Office of Information Technology. If you knowingly share your password with someone else and this policy is violated, you will also be subject to the sanctions outlined in Section 6.0. If file sharing with others is necessary, there are methods and techniques to accomplish this without sharing your userid and password. Remember that your password is the first line of defense against unauthorized access to your account. The person in whose name an account is issued is responsible at all times for its proper use. 1. Users must not give a password to another user. 2. Users should change passwords frequently. 3. Users should choose a password that cannot be easily guessed by others. 4. Users should use a combination of letter and numbers in their password. 5.2.2 Unauthorized Access

You must not attempt to guess or break another user’s password. Attempts to gain access to GMC computers and networks to which you are not authorized is prohibited. You may not use GMC facilities to login or attempt to login to computers external to GMC to which you are not authorized. If you suspect that your account has been compromised, you should contact the Office of Information Technology. 5.2.3 Providing Services

Users are not permitted to provide network or computer-based services using GMC computers or networks without prior permission from the Office of Information Technology. Examples of such services include, but are not limited to, file transfer protocol (FTP) and WEB servers. 5.2.4 Internet Access

Because access to the Internet provides connections to other computer systems located all over the world, users (and parents of users, if the user is under 18 years old) must understand that Georgia Military College does not control the content of the information available on these other systems. Some of the information available is controversial and, sometimes, offensive. Georgia Military College does not condone the use of other materials. School employees, students and parents of students must be aware that access to the Internet will be withdrawn from users who do not respect the rights of others or do not follow the rules and regulations established by Georgia Military College. 5.2.5 Unauthorized Monitoring

Users are not permitted to use computers and networks to monitor electronic transmissions. 5.2.6 Disruption of Operations

Deliberate attempts to disrupt the operation or degrade the performance of computers or networks are prohibited. 5.2.7 Circumvention of Policies

Do not circumvent or attempt to circumvent any policies or procedures that have been established to ensure equable resource distribution in our shared computing environment. For example, you must not deliberately circumvent the modem inactivity timer. 5.2.8 Game Playing

The policy regarding game playing on GMC computers and networks is established by the department responsible for the user in question. However, no department should permit game playing to interfere with normal College business. 5.2.9 Use of Copyright or Licensed Materials

There shall be no coping or installation of software on GMC computers if such coping or installation would violate any copyright or licensing agreement. You may be asked to show a valid license agreement to ensure the legal use of software on GMC computers. Contact the Office of Information Technology if you have any questions regarding licensing issues. 6.0 Sanctions

Violators of this policy may be subject to one or more of the following sanctions which can be imposed by the Office of Information Technology upon consultation with the violators’ supervisor or teacher. 1. admonition 2. temporary or permanent suspension of computer privileges 3. temporary or permanent suspension of lab privileges Additional sanctions, such as suspension and employee action, may also apply as outlined in the SOP. Legal action can also be taken as per Section 6.1. Appeals to these sanctions are explained in Section 6.2. 6.1 Legal Restraints

Users of GMC computing facilities are expected to abide by State and Federal laws that apply to the usage of computers. These laws exist to “establish certain acts involving computer fraud or abuse as crimes punishable by defined fines or imprisonment or both”. As an example, the Georgia Computer Systems Protection Act was enacted in 1991 to “provide for criminal liability and definition of penalties for the crimes of computer theft, computer trespass, computer invasion of privacy, computer forgery, and computer password disclosure”. The penalties range from fines up to $50,000 and imprisonment up to 15 years. The full text of this act and others are available via GMC gopher and World Wide Web. 6.2 Appeals

Appeals to sanction should be handled through the existing College grievance and appeals for both employees and students.

Computer Acceptable Use & Ethics From the GMC Computer Acceptable Use and Ethics Policy the following rules and regulations apply: It is a privilege to receive a computer account. The account receives free Internet access. A RESPONSIBLE computer user may keep an account as long as the user is an Employee or student at Georgia Military College. Responsible users may : Use network software to complete class assignments. Use the Internet to research assigned classroom projects. Use the Internet to send electronic mail 9e-mail) to other users. Use the Internet to access other computer systems. Responsible users : May NOT use the Internet for any illegal purpose. May NOT use impolite or abusive language. May NOT violate the rules of common sense and etiquette. May NOT change any computer files that do not belong to the user. May not send or get copyright material without permission. May NOT create malicious or destructive programs. Users must not give their password to anyone. Users are responsible for backing up their own user areas The use of cell phones and pagers is NOT allowed in classrooms or labs at Georgia Military College.

I have read the GMC Computer Use and Ethics Policy and I agree to abide by the rules and regulations. If I do not follow the rules, I understand that my network account will be taken away. _______________________________________________

Print Name

___________________________________________\_____\_____\_____

Student Signature/Date

All students under age 18 need parents signature. I have read the Computer Acceptable Use and ethics policy for Georgia Military College. I understand that the Internet is a worldwide group of hundreds of thousands of computer networks. I know that Georgia Military College does not control the content of these Internet networks. When using the Internet, I realize that students may read material that is controversial or offensive. I give my permission to issue a computer account allowing Internet access to my child. I understand that my child may keep this account as long as the procedures described in the Georgia Military College Acceptable Use Policy are followed.

_____________________________________________\_____\_____\_____

Parent Signature/Date

GMC Prep School Student Information Sheet for: GRADE(SY12-13) _____

SEX: ______ RACE: ______________

____________________________________________________________________ GOES BY: ______________________ First

Middle

Last

STUDENT’S CELL NUMBER: (_____)___________________

HOME PHONE NUMBER: (_____)___________________

SSN: _____________________ BIRTHDATE:________________ COUNTY OF RESIDENCE: __________________ STUDENT LIVES WITH:

___ Parents ___Mother ___Father ___ Other: ________________

PARENT(S)/GUARDIAN(S) - Legal documentation must be provided if a parent(s) should not have access to this student’s academic information. Otherwise, both mother and father are considered emergency contacts, may sign student in/out, and will have access to academic information. Report Cards are available on Edline at the end of each quarter. They are only mailed at the end of the school year. Who should receive a copy of the final report card? ___Parents ___Mother ___Father ___Other: ________________________ LEGAL GUARDIAN(S) ____ Parents ____Mother ____Father ____Other: ___________________________

FATHER:

_____________________________________ First

MI

Last

MOTHER: _____________________________________ First

MI

Last

STEP-PARENT/

GUARDIAN: ______________________________________ First

MI

Last

ADDRESS: _____________________________________

ADDRESS: _____________________________________

ADDRESS: ______________________________________

_____________________________________

_____________________________________

______________________________________

City

Sate

Zip

City

Sate

Zip

City

Sate

Zip

HOME PHONE: ________________________

HOME PHONE: ________________________

HOME PHONE: ________________________

OCCUPATION: _________________________________

OCCUPATION: _________________________________

OCCUPATION: __________________________________

PLACE OF _____________________________________ EMPLOYMENT

PLACE OF _____________________________________ EMPLOYMENT

PLACE OF _____________________________________ EMPLOYMENT

WORK PHONE: ________________________

WORK PHONE: ________________________

WORK PHONE: ________________________

CELL PHONE:

CELL PHONE:

CELL PHONE:

________________________

E-MAIL ADDRESS: ______________________________ __________________________________________________________ FATHER’S SIGNATURE

________________________

E-MAIL ADDRESS: ______________________________

________________________

E-MAIL ADDRESS: _______________________________

___________________________________________________________ MOTHER’S SIGNATURE

_______________________________________________________________ STEP-PARENT’S/GUARDIAN’S SIGNATURE

SIBLING(S) WHO WILL ALSO ATTEND GMC PREP SCHOOL: Sibling’s Name_____________________________ Grade:______

Sibling’s Name____________________________ Grade:______ Sibling’s Name____________________________ Grade:_______

PLEASE LIST BELOW THE ADULTS THAT ARE TO BE NOTIFIED IN AN EMERGENCY SITUATION &THAT ARE ALLOWED TO SIGN OUT STUDENT DURING THE SCHOOL YEAR: (1st Contact) Name _______________________________ Relationship ___________________

(2nd Contact) Name ____________________________________ Relationship ____________________

Home Phone ___________________ Work Phone ____________________ Cell ____________________

Home Phone _____________________ Work Phone ______________________ C ell ______________________

(3rd Contact) Name _______________________________ Relationship __________________

(4thContact) Name ______________________________________ Relationship ___________________

Home Phone ___________________ Work Phone ____________________ Cell ____________________

Home Phone _____________________ Work Phone ______________________ C ell ______________________

First

First

Last

Last

First

First

Last

Last

GMC Prep School Request for Student Records ***PARENTS PLEASE NOTE THE F0LLOWING: You are responsible for the submission of this document to the school that your child currently attends.

To: Registrar/Guidance Office ________________________________________________________ School ________________________________________________________ Address ________________________________________________________ City State Zip

Please release all available student records to include, but not limited to, test scores, transcripts, student support services records, discipline history, birth certificate, FTE number, and special education records on the following student for the purpose of enrollment: _____________________________________________________________

Student's Name

Parent/Guardian - Please Select One Option: Please mail the above records to: Office of the Principal Georgia Military College Prep School 201 E. Greene Street Milledgeville, GA 31061 I will pick up the above student records and deliver them to Georgia Military College Prep School. I understand that to be considered official, the information must be in the original sealed envelope from the school. Please contact me at this phone number, (_____)____________________ when the student records are ready for pickup. _________________________________________________________

Parent /Guardian Signature

_________________________________________________________

Date

Note: According to the Final Regulation-Family Educational Rights and Privacy Act dated June 17, 1976, it is no longer necessary to obtain parental permission when records are requested by authorized school personnel.

Revised 11/28/2011

Health Information/Requirements Medical Release Form All GMC Prep School students must have a current Medical Release Form signed by a parent or legal guardian. This form provides pertinent medical information and emergency contact information along with authorization for treatment in the school clinic. This form also allows authorized school personnel to consent on the parent/guardians behalf in an emergency situation.

Certificate of Eye, Ear & Dental Form (EED) Georgia law requires that any child transferring or entering a Georgia school for the first time shall not be admitted unless the child has a Certificate of Eye, Ear, & Dental Form (Georgia Department of Human Resources Form #3300).

Georgia Military College Prep School’s policy requires ALL prospective students to have a current/up-to-date Certificate of Eye, Ear, & Dental Form. The initial EED is obtained prior to attending kindergarten. These screenings are recommended at adolescence to ensure that problems are identified and corrected. This form may be obtained from the county health department, from a licensed Georgia physician or GMC Health Services.

Certificate of Immunization Georgia law requires all children entering school to show proof of immunizations with a Certificate of Immunization (Georgia Department of Human Resources Form # 3231).

ALL prospective students, including ones who are transferring from another state or who are attending school in Georgia for the first time, must provide GMC Prep School with an up-to-date Certificate of Immunization. New immunization requirements have been added to the immunization schedule since your adolescent started school. This form may be obtained from the county health department, from a licensed Georgia physician or if all immunizations are current GMC Health Services can access a certificate through the Georgia Registry of Immunization Transactions & Services (GRITS).

Physical Requirement All prospective students must provide a completed Pre-participation GMC Evaluation which includes a Medical History Form, Physical Examination Form, and Clearance Form. The medical history form must be completed by the parent/guardian. Physical examinations will be good for twelve (12) months from the date of exam. The physical exam must be conducted and signed along with the clearance form by a licensed medical physician or doctor of osteopathic medicine, a nurse practitioner or a physician’s assistant. Students must have a certificate of physical examination on file at the school that indicates the student is physically approved for participation prior to any athletic try-outs, practices, or games. The Georgia High School Association (GHSA) requires that member schools use the physical examination form approved by the American Academy of Pediatrics, which is included in this packet. Contact Georgia Military College Health Services at (478)387-4839 or (478)387-4725 for additional information or questions regarding health requirements.

Revised 11-28-2011

Georgia Military College Prep School

MEDICAL RELEASE FORM

AUTHORIZATION TO ADMINISTER MEDICAL TREATMENT

School Year 2012-13 I, _____________________________________, the parent, or guardian, or sponsor of ________________________________________, (Print Name of Parent or Guardian or Sponsor’s Name)

(Print Name of Student)

a minor child who is a commuting student at Georgia Military College Prep School, living with parent/guardian/sponsor, do hereby give: My consent, that in the event all reasonable attempts by authorized school personnel to contact me have been unsuccessful, for the Principal of Georgia Military College Prep School, or his designated representative, to consent on my behalf to any x-ray examination, anesthetic, medical treatment, and hospital care of my minor child, as fully and effectively as if I were personally present. I authorize the above-mentioned officials of Georgia Military College to serve in “loco parentis” for the transfer of an authorization of administration of any treatment deemed necessary for the treatment of my minor child. I authorize the School Nurses of Georgia Military College to administer medications or treatments to my minor child according to the School Physician’s Standing Orders/Nurse Protocol. I will be responsible for any medical or hospital fees or costs associated with the illness or treatment of this minor. This authorization is granted pursuant to the provision of O.C.G.A. 31-9-2 (2) (4) of the Georgia Medical Consent Law. Name of Student (Please Print) : _________________________________ First

MI

Last

_________________________________________ Signature of Parent, Guardian, or Sponsor

_____________ Date

Allergies: ______________________________________________

Medical Conditions: ______________________________________________________________

Medications: ________________

__________________________________________________________

______________________________________________________________

___________________________________________

__________________________________________________________

_______________________________________________________________

___________________________________________

__________________________________________________________

_______________________________________________________________

__________________________________________

PARENT/GUARDIAN TO NOTIFY IN AN EMERGENCY SITUATION: (1st Contact) Name ______________________________

Relationship __________________

(2nd Contact) Name ___________________________________ Relationship _____________________

Address _______________________________________

Home Phone __________________

Address ____________________________________________ Home Phone _____________________

_______________________________________

Work Phone ___________________

____________________________________________ Work Phone _____________________

Cell Phone ____________________

Cell Phone ______________________

First

City

MI

State

Last

Zip

Place of Employment _____________________________ Occupation _________________________

First

City

MI

Last

State

Zip

Place of Employment _________________________________

Occupation _____________________

■■ Preparticipation Physical Evaluation 

HISTORY FORM

(Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.) Date of Exam ____________________________________________________________________________________________________________________ Name _ __________________________________________________________________________________ Date of birth ___________________________ Sex ________ Age _ __________ Grade ______________ School ______________________________ Sport(s) ___________________________________ Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking

Do you have any allergies?     Yes    No  If yes, please identify specific allergy below.   Medicines   Pollens   Food

  Stinging Insects

Explain “Yes” answers below. Circle questions you don’t know the answers to. GENERAL QUESTIONS

Yes

No

MEDICAL QUESTIONS

1. Has a doctor ever denied or restricted your participation in sports for any reason?

26. Do you cough, wheeze, or have difficulty breathing during or after exercise?

2. Do you have any ongoing medical conditions? If so, please identify below:   Asthma    Anemia    Diabetes    Infections Other: ________________________________________________

27. Have you ever used an inhaler or taken asthma medicine? 29. Were you born without or are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ?

4. Have you ever had surgery?

30. Do you have groin pain or a painful bulge or hernia in the groin area? Yes

No

31. Have you had infectious mononucleosis (mono) within the last month?

5. Have you ever passed out or nearly passed out DURING or AFTER exercise?

32. Do you have any rashes, pressure sores, or other skin problems?

6. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?

34. Have you ever had a head injury or concussion?

33. Have you had a herpes or MRSA skin infection? 35. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

7. Does your heart ever race or skip beats (irregular beats) during exercise? 8. Has a doctor ever told you that you have any heart problems? If so, check all that apply:   High blood pressure   A heart murmur   High cholesterol   A heart infection   Kawasaki disease Other: ______________________

36. Do you have a history of seizure disorder? 37. Do you have headaches with exercise? 38. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling? 39. Have you ever been unable to move your arms or legs after being hit or falling?

9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, echocardiogram) 10. Do you get lightheaded or feel more short of breath than expected during exercise?

40. Have you ever become ill while exercising in the heat?

11. Have you ever had an unexplained seizure?

42. Do you or someone in your family have sickle cell trait or disease?

12. Do you get more tired or short of breath more quickly than your friends during exercise?

43. Have you had any problems with your eyes or vision?

HEART HEALTH QUESTIONS ABOUT YOUR FAMILY

41. Do you get frequent muscle cramps when exercising?

Yes

No

13. Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)?

48. Are you trying to or has anyone recommended that you gain or lose weight? 49. Are you on a special diet or do you avoid certain types of foods? 50. Have you ever had an eating disorder? 51. Do you have any concerns that you would like to discuss with a doctor? FEMALES ONLY

16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?

18. Have you ever had any broken or fractured bones or dislocated joints?

45. Do you wear glasses or contact lenses? 47. Do you worry about your weight?

15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator?

17. Have you ever had an injury to a bone, muscle, ligament, or tendon that caused you to miss a practice or a game?

44. Have you had any eye injuries? 46. Do you wear protective eyewear, such as goggles or a face shield?

14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia?

BONE AND JOINT QUESTIONS

No

28. Is there anyone in your family who has asthma?

3. Have you ever spent the night in the hospital? HEART HEALTH QUESTIONS ABOUT YOU

Yes

52. Have you ever had a menstrual period? Yes

No

53. How old were you when you had your first menstrual period? 54. How many periods have you had in the last 12 months? Explain “yes” answers here

19. Have you ever had an injury that required x-rays, MRI, CT scan, ­injections, therapy, a brace, a cast, or crutches? 20. Have you ever had a stress fracture? 21. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down syndrome or dwarfism) 22. Do you regularly use a brace, orthotics, or other assistive device? 23. Do you have a bone, muscle, or joint injury that bothers you? 24. Do any of your joints become painful, swollen, feel warm, or look red? 25. Do you have any history of juvenile arthritis or connective tissue disease?

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Signature of athlete ___________________________________________ Signature of parent/guardian_ ____________________________________________________________ Date______________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE0503

9-2681/0410

■■ Preparticipation Physical Evaluation 

THE ATHLETE WITH SPECIAL NEEDS: SUPPLEMENTAL HISTORY FORM

Date of Exam ____________________________________________________________________________________________________________________ Name _ __________________________________________________________________________________ Date of birth ___________________________ Sex ________ Age _ __________ Grade ______________ School ______________________________ Sport(s) ___________________________________ 1. Type of disability 2. Date of disability 3. Classification (if available) 4. Cause of disability (birth, disease, accident/trauma, other) 5. List the sports you are interested in playing Yes

No

Yes

No

6. Do you regularly use a brace, assistive device, or prosthetic? 7. Do you use any special brace or assistive device for sports? 8. Do you have any rashes, pressure sores, or any other skin problems? 9. Do you have a hearing loss? Do you use a hearing aid? 10. Do you have a visual impairment? 11. Do you use any special devices for bowel or bladder function? 12. Do you have burning or discomfort when urinating? 13. Have you had autonomic dysreflexia? 14. Have you ever been diagnosed with a heat-related (hyperthermia) or cold-related (hypothermia) illness? 15. Do you have muscle spasticity? 16. Do you have frequent seizures that cannot be controlled by medication? Explain “yes” answers here

Please indicate if you have ever had any of the following. Atlantoaxial instability X-ray evaluation for atlantoaxial instability Dislocated joints (more than one) Easy bleeding Enlarged spleen Hepatitis Osteopenia or osteoporosis Difficulty controlling bowel Difficulty controlling bladder Numbness or tingling in arms or hands Numbness or tingling in legs or feet Weakness in arms or hands Weakness in legs or feet Recent change in coordination Recent change in ability to walk Spina bifida Latex allergy Explain “yes” answers here

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Signature of athlete ___________________________________________ Signature of parent/guardian_ __________________________________________________________

Date______________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

■■ Preparticipation Physical Evaluation 

PHYSICAL EXAMINATION FORM

Name _ __________________________________________________________________________________ Date of birth ___________________________

PHYSICIAN REMINDERS

1.  Consider additional questions on more sensitive issues • Do you feel stressed out or under a lot of pressure? • Do you ever feel sad, hopeless, depressed, or anxious? • Do you feel safe at your home or residence? • Have you ever tried cigarettes, chewing tobacco, snuff, or dip? • During the past 30 days, did you use chewing tobacco, snuff, or dip? • Do you drink alcohol or use any other drugs? • Have you ever taken anabolic steroids or used any other performance supplement? • Have you ever taken any supplements to help you gain or lose weight or improve your performance? • Do you wear a seat belt, use a helmet, and use condoms? 2.  Consider reviewing questions on cardiovascular symptoms (questions 5–14). EXAMINATION Height Weight   Male   Female BP / ( / ) Pulse Vision R 20/ L 20/ Corrected    Y    N MEDICAL NORMAL ABNORMAL FINDINGS Appearance • Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency) Eyes/ears/nose/throat • Pupils equal • Hearing Lymph nodes Heart a • Murmurs (auscultation standing, supine, +/- Valsalva) • Location of point of maximal impulse (PMI) Pulses • Simultaneous femoral and radial pulses Lungs Abdomen Genitourinary (males only)b Skin • HSV, lesions suggestive of MRSA, tinea corporis Neurologic c MUSCULOSKELETAL Neck Back Shoulder/arm Elbow/forearm Wrist/hand/fingers Hip/thigh Knee Leg/ankle Foot/toes Functional • Duck-walk, single leg hop Consider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. Consider GU exam if in private setting. Having third party present is recommended. Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.

a

b c

 Cleared for all sports without restriction  Cleared for all sports without restriction with recommendations for further evaluation or treatment for __________________________________________________________________

_____________________________________________________________________________________________________________________________________________

 Not cleared

 Pending further evaluation



 For any sports



 For certain sports ______________________________________________________________________________________________________________________



Reason ____________________________________________________________________________________________________________________________

Recommendations __________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________ I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians). Name of physician (print/type) _____________________________________________________________________________________________________ Date ________________ Address ___________________________________________________________________________________________________________ Phone _________________________ Signature of physician _______________________________________________________________________________________________________________________, MD or DO ©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE0503

9-2681/0410

■■ Preparticipation Physical Evaluation 

CLEARANCE FORM

Name ___­­­­­____________________________________________________ Sex   M   F

Age _________________ Date of birth _________________

 Cleared for all sports without restriction  Cleared for all sports without restriction with recommendations for further evaluation or treatment for ________________________________________________

___________________________________________________________________________________________________________________________

 Not cleared

 Pending further evaluation



 For any sports



 For certain sports______________________________________________________________________________________________________



Reason _ ___________________________________________________________________________________________________________

Recommendations _______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians). Name of physician (print/type) ___________________________________________________________________________________ Date ________________ Address _________________________________________________________________________________________ Phone _________________________ Signature of physician _____________________________________________________________________________________________________, MD or DO

EMERGENCY INFORMATION Allergies _______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ Other information _ _______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________ ©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

Georgia Military College Prep School

Financial Aid/Scholarships Completed Financial Aid/Scholarship Applications and supporting documentation for Prospective & Current students must be received in the GMC Prep School Office (201Usery Hall) not later than

Thursday, March 8, 2012.

Georgia Military College is proud to offer the following scholarships to help offset the cost of tuition. Georgia Military College Prep School Financial Aid Scholarship The following documentation must be provided. 1. A completed Georgia Military College Prep School Financial Aid Scholarship Application. 2. The parent/guardians’ 2011 Tax Return. 3. The parent/guardians’ 2011 W-2 forms. 4. If you will not file a tax return, you must provide a statement of untaxed Income and/or benefits. Eligibility is based on:   

Financial Need Grades- Eligibility for the scholarship is determined by GPA level. Conduct- Eligibility for the scholarship is affected by suspensions and unacceptable behavior as defined in the student handbook.

Lillian Womble Baugh Scholarship The following documentation must be provided: A completed Lillian Womble Baugh Scholarship Application. Eligibility is based on:  Financial Need  Grades- 80.0 or above academic average.  Exhibit good character.

GMC Alumni Association Scholarships The following documentation must be provided: A completed GMC Alumni Association Scholarship Application. Eligibility is based on:  Recipient’s father, mother, grandfather or grandmother must be an alumnus (alumna) of Georgia Military College (having attended GMC prep or junior college for a year or more).  Financial Need  Grades- 80.0 or above academic average.  Exemplary character. Financial Aid/Scholarship awards will cover tuition and fees only. All students must pay for their uniforms. Textbooks are furnished to all students by Georgia Military College Prep School.

* Please fill in all blanks. If the item does not apply, please fill in the blank with: O or N/A (not applicable).

GEORGIA MILITARY COLLEGE PREP SCHOOL FINANCIAL AID APPLICATION FOR 2012-2013

Completed Financial Aid Applications and supporting documentation for ALL students must be received in the GMC Prep School Office (201Usery Hall) not later than March 8, 2012. ♦

All current students who wish to be a recipient of the Financial Aid Scholarship must apply/reapply for this scholarship each year.

(PLEASE PRINT)

STUDENT INFORMATION: Name: ______________________________ (First)

________________________________ (Middle)

Social Security Number:_____________________________

______________________________ (Last)

Date of Birth:_______________

Grade for 2012-13:________

Mailing Address: ___________________________________________________________________ ___________________________________________________________________

PARENT(S)/LEGAL GUARDIAN’S INFORMATION: Parent(s)/Legal Guardian’s Names ________________________________________ Current Marital Status:

_____Single

_____Married

_____________________________________

_____Separated _____Divorced _____Widowed

Age of Oldest Parent/Guardian ______ Home Telephone Number: ______________________ Cell Number(s): ______________________ Work Telephone Number(s) ____________________________

______________________

____________________________

Parent/Guardian’s Email Address ________________________________________

_____________________________________

FINANCIAL/INCOME INFORMATION: You must submit a copy of your signed 2011 U.S. Tax Return &W-2’s, and/or a statement of any untaxed income and/or benefits reported with this application. ***Your application is incomplete without this supporting documentation***

Please provide information regarding your 2011 income, earnings, and benefits. 1.

The following income figures are from: ________

A completed 2011 IRS Form 1040A, 1040EZ, or 1040TEL

________

A completed 2011 IRS Form 1040

________

We will not file a 2011 U.S. income tax return and will provide a statement for untaxed income and/or benefits reported with this application including Child Support. (Skip to Question #4) FOR SCHOOL USE ONLY *****************************

2. 2011 Adjusted Gross Income: $_____________ (Form 1040 – line 37, 1040A – line 21, 1040EZ – line 4)

3. 2011 U.S. Income Tax paid: $____________ (Form 1040 – line 55, Form 1040A – line 35, 1040EZ – line 11)

4. 2011 Income earned from work (father/step-father): $____________ (Form W-2 or 1099)

5. 2011 Income earned from work (mother/step-mother): $____________ (Form W-2 or 1099)

DATE REC’D IN PRINCIPAL’S OFFICE _____________

REC’D BY

________

O Current Student

O Prospective Student

O Taxes

O Statement/Benefits

O W-2’s

O No W-2’s Self-employed

Date Scanned _______________________________________________

Routed ___________________________________

By _________________________________

M/NM _ _______________________________

6. Untaxed income received in 2011(include amounts even for children not attending GMC): $____________ Payments to tax-deferred pension and savings plans $____________ Child support received $____________ IRA deductions and payments to self-employed SEP, SIMPLE and Keogh $____________ Tax exempt interest income $____________ Untaxed portions of IRA distributions $____________ Untaxed portions of pensions $____________ Housing, food and other living allowances paid to members of the military, clergy & others $____________ Veterans non-education benefits $____________ Other untaxed income not reported, such as worker’s compensation or disability.

$___________ Grand Total Untaxed Income

7. Additional financial information from 2011: $____________ Hope & Lifetime Learning tax credits $____________ Child Support paid $____________ Taxable earnings from work-study, assistantships or fellowships $____________ Grant and scholarship aid reported to the IRS $____________ Combat pay or special combat pay $____________ Cooperative education program earnings

$___________ Grand Total Additional Financial Info

ASSET INFORMATION 8. As of today, what is the total current balance of cash, savings, and checking accounts? $____________ 9. As of today, what is the net worth of your investments, including real estate? $:____________ (Do not include home)

10. As of today, what is the net worth of current businesses and/or investment farms? $_____________

Household Information List all family members who are currently residing in the household. List the name and relationship to parent for each family member. This list should include the student, parent(s), step-parent(s), and other family members who receive more than half of their support from parents. Indicate any children who are attending either the GMC Prep School (this includes prospective/new students) or college at least half time for the 2012-2013 academic year. NAME

RELATIONSHIP

SCHOOL

________________________________________

____________________________

Attends: O GMC Prep

O GMC COLLEGE

________________________________________

____________________________

Attends: O GMC Prep

O GMC COLLEGE

________________________________________

____________________________

Attends: O GMC Prep

O GMC COLLEGE

________________________________________

____________________________

Attends: O GMC Prep

O GMC COLLEGE

________________________________________

____________________________

Attends: O GMC Prep

O GMC COLLEGE

________________________________________

____________________________

Attends: O GMC Prep

O GMC COLLEGE

In 2011, did you (or your spouse) receive benefits from any of the federal benefit programs listed below? _______ If yes, please check the appropriate box. Supplemental Security Income (SSI)

Food Stamps

Free or Reduced Price School Lunch

Temporary Assistance for Needy Families (TANF)

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) If your 2011 expected income will change significantly from your 2011 reported income, please use the area below to explain the reason for any change. You will be required to provide supporting documentation to verify your explanation. After initial review of your application, you will be notified regarding what specific documents will be required. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

CERTIFICATION: All of the information provided on this form by me or any other person is true and complete to the best of my knowledge. I understand that this application is being filed jointly by all signatories. I agree to provide a copy of my signed 2011 Federal Tax Return, W-2’s and/or a statement of any untaxed income and/or benefits reported. I understand that my application is incomplete without this supporting documentation. Parent/Guardian:____________________________________________ Signature

Date Completed:_______________________

2012-2013 Scholarship Application

To be eligible for this scholarship, the applicant must be in financial need for assistance, must have at least an 80.0 or above grade point average and exhibit good character.

(Completed scholarship applications must be received in GMC Prep School Office (201 Usery Hall) not later than March 8, 2012.)

Student’s Grade (2012-2013): _____ Student’s Name: _____________________ _________________ ___________________________ First

Student’s Mailing Address:

Middle

Last

___________________________________________________________ Street or P. O. Box Number

___________________________________________________________ City

State

Zip Code

Student Lives With: ____ Parents ____Mother ____Father ____ Other: ___________________________________ Parent(s)/Legal Guardian’s Name ______________________________________ Mother

_______________________________________ Father

Home Phone: (____)_______________ Mother’s Work Phone: (____)________________ Father’s Work Phone: (____)_________________

1. Number of family members in household 2012-2013: _____ (Include parents, yourself and any other persons who get more than half their support from your parents) 2. Number of family members in household attending Georgia Military College Prep School in 2012-2013 ______ Please list: Name ______________________________ Grade _______

Name _________________________________ Grade ________

Name ______________________________ Grade _______

Name _________________________________ Grade ________

3. Number of family members in household attending Georgia Military College in 2012-2013 ______ Please list: Name ____________________________

Name _____________________________

Name _____________________________

4. Number of family members in household who will be attending college other than any listed in #3 above in 2012-2013 _______ Name ____________________________

Name _____________________________

Name _____________________________

Total Family Income:

0 - $14,999

$30,000 - $44,999

$15,000 - $29,999

$45,000 or above

I hereby declare that I will maintain a satisfactory scholastic and discipline record at GMC. ____________________________________________________ Student’s Signature

I hereby apply for consideration for the Lillian Womble Baugh Trust and authorize the school to release whatever information it deems necessary to the members of the Lillian Womble Baugh Trust. My reasons for applying for the Trust are (Explain any unusual expense, educational and other debts or special circumstances):

________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ___________________________________________________ Parent/Guardian Signature

**********************************************************************************************************************************************************************************

For School Use Only

Academic Average: _________

Discipline Record: No. of In School Suspensions ___________ No. of At-Home Suspensions ___________

Current Student - Date received __________________

Prospective Student - Date Received __________________

To be eligible for this scholarship, either a parent or grandparent of the applicant must be a GMC Alumni and the applicant must be in financial need for assistance. Completed scholarship applications must be received in GMC Prep School Office (201 Usery Hall) not later than March 8, 2012

Name of GMC Alumni: _______________________________ & Relationship to Student ________________________ Student’s Name: _______________________________ ______________________________ ______ Last

Student’s Mailing Address :

First

M.I.

___________________________________________________________ Street or P. O. Box Number

___________________________________________________________ City

State

Zip Code

Student Lives With: ____ Parents ____Mother ____Father ____ Other: ______________________________________ Parent(s)/Legal Guardian’s Name ______________________________________ Mother

_______________________________________ Father

Home Phone: (____)_______________ Mother’s Work Phone: (____)________________ Father’s Work Phone: (____)_________________

1. Number of family members in household 2012-2013: _____ (Include parents, yourself and any other persons who get more than half their support from your parents) 2. Number of family members in household attending Georgia Military College Prep School in 2012-2013 ______ Please list: Name ______________________________ Grade _______

Name _________________________________ Grade ________

Name ______________________________ Grade _______

Name _________________________________ Grade ________

3. Number of family members in household attending Georgia Military College in 2012-2013 ______ Please list: Name ____________________________

Name _____________________________

Name _____________________________

4. Number of family members in household who will be attending college other than any listed in #3 above in 2012-2013 _______ Name ____________________________

Name _____________________________

Name _____________________________

Total Family Income:

0 - $14,999

$30,000 - $44,999

$15,000 - $29,999

$45,000 or above

I hereby declare that I will maintain a satisfactory scholastic and discipline record at GMC. ____________________________________________________ Student’s Signature

I hereby apply for consideration for the GMC Alumni Scholarship Fund and authorize the school to release whatever information it deems necessary to the members of the GMC Alumni Scholarship Fund. My reasons for applying are (Explain any unusual expense, educational and other debts or special circumstances):

________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ___________________________________________________ Parent/Guardian Signature

**********************************************************************************************************************************************************************************

For School Use Only

Academic Average: _________

Discipline Record: No. of In School Suspensions ___________ No. of At-Home Suspensions ___________

Current Student - Date received __________________

Prospective Student - Date Received __________________

GMC Prep School

Uniform List SY 2012-13 Item

Price

Recommend

Subtotal

3 3 2 1 1 1 2 2 1 1 2 2 1 2 2 1 1 1 1 1

$75.75 $80.40 $112.30 $11.55 $4.00 $4.00 $24.40 $33.20 $9.10 $68.50 $10.50 $10.00 $45.00 $31.90 $12.50 $29.00 $14.95 $13.95 $3.50 $28.50

Male Female

$585.80

(Subject to Change)

Shirt, White short sleeve (with round patch) Shirt, White long sleeve (with round patch) Trousers, Blue/Gray Belt, w/Brass buckle, No Shine Tie, Black (female) Tie, Black (male) Hat, Garrision (male) Hat, Garrison (female) Gloves, Black Black Jacket GMC Letters, brass (pair) GMC Crest Shoes, Black Patent Leather Shorts, Gym Black (Mesh) P.E. Shirt Trousers, Dress Black Sweatpants, GMC Gray Sweatshirt, GMC Gray Epaulets for E1-pair (MS only) Shirt, Official Red (Short Sleeve) (Prices higher for larger sizes)

$25.25 $26.80 $56.15 $11.55 $4.00 $4.00 $12.20 $16.60 $9.10 $68.50 $5.25 $5.00 $45.00 $15.95 $6.25 $29.00 $14.95 $13.95 $3.50 $28.50

TOTAL

Other Required Items: Name Tape for Black Jacket (Purchased from Sew K Designs - Karin Smith 478-453-7852)

T-Shirt, White Crew Neck Name Tag, Black Plastic (May be purchased at Baldwin Trophies & Awards, J.C. Grant Co.)

White Socks - P.E., Black Socks - Uniform Gym shoes (non -marking) Gym bag Umbrella, black collapsable Book Bag (Any type) High School will need to purchase JROTC patch for each shirt $1.75ea.

1 4 2

$594.60