achieve.nobles@gmail.com 2012 APPLICATION CHECKLIST

Achieve at Noble and Greenough School2012 APPLICATION CHECKLISTAll forms may be mailed or faxed to:Achieve10 Campus DriveDedham, MA 02026Fax: (781) 320-1329achieve.nobles@gmail.comApplication Deadline: March 16, 2012TO BE COMPLETED AND SUBMITTED BY THE STUDENT/FAMILY: Form 1: Family Information Please submit 1040 and W-2 forms for 2011 for your household with this form. Allinformation will be kept completely confidential.• Family income must be at or below the following levels:• Family of 2: $48,160• Family of 3: $52,057• Family of 4: $60,670• Family of 5: $69,658• Family of 6 or more: $78,155 Form 2: Student Statement• Please hand-write using black or blue ink. Form 3: Parent/Guardian Statement• Please use black or blue ink.• Attendance is mandatory for all components of the program. Please ensure thatyour family can commit to all of the following dates:• Summer 2012: June 25 - August 3• Academic Year 2012-2013: Two Saturdays per month (8am – 1pm)• Summer 2013: Last week of June through first week of August• Academic Year 2013-2014: Two Saturdays per month (8am – 1pm)• Summer 2014: Last week of June through first week of AugustTO BE COMPLETED AND SUBMITTED BY THE SCHOOL: Form 4A: Current English or Math Teacher Reference (Required)• Please submit the form to your teacher as soon as possible.

• This form is confidential and must be submitted directly to Achieve by theteacher. We will not accept reference forms submitted by the applicant. Form 4B: Additional Teacher Reference (Strongly Recommended)• May be completed by a current or recent teacher.• This form is confidential and must be submitted directly to Achieve by theteacher. We will not accept reference forms submitted by the applicant. Form 5: Transcript Release Form• Please sign form and submit to your child’s teacher, guidance counselor, orschool secretary.• This information must be submitted directly to Achieve by the school. We willnot accept transcripts submitted by the applicant.NEXT STEPS:• Applicants will be notified (by email) when all application materials have beenreceived.• Applications will be reviewed by the admissions committee.• All applicants will be notified of their status within three weeks.• Only select students will be invited for a family interview.ADDITIONAL NOTES:• Due to the significant number of applications we receive, not all applicants will beinvited to interview.• Priority for admission will be given to students from Boston Public School (includescharter and pilot schools).• METCO and parochial school students are welcome to apply but will be automaticallyplaced on a waiting list and considered if spaces remain available after May 1, 2012.• Students who attend independent/private schools are NOT eligible to apply.• Applications submitted after the deadline will be automatically placed on a waiting listand considered if spaces remain available after May 1, 2012.If you have additional questions please feel free to contact the Achieve office.Email: achieve.nobles@gmail.comPhone: (781) 320-7125Visit our website at: www.nobles.edu/achieve