Denver Public Schools

Smiley Middle School

International Baccalaureate Middle Years Program

Pre-registration Form

(Please Print)

Present Grade ___

 

Name:_______________________________________ Student ID: ___________________ Sex: _______

                 (Last Name)                            (First Name)

Street Address:_____________________________________ Home phone:_________________________

 

City: ___________________ State:____________________ Zip Code: ____________________________

 

Date of Birth: _______________________ State/Country of birth: ________________________________

                                (Month/Day/Year)                                                                   (State/Country)

 

Ethnicity: __Amer. Indian __ African Amer. __Asian __Hispanic __White      Language Spoken:________

 

Current School: ___________________________ Denver Neighborhood Middle School:______________

 

Do you already play an instrument?(Yes or No) _______________ Are you interested in band?(Yes or No)

                                                                                                (Instrument)

Person to contact:

                Mother’s Name: ___________________________ Mother’s Phone Number: _________________

 

                Father’s Name: ____________________________Father’s Phone Number: __________________

 

Check here to be considered for Honors______

 

An official copy of the most recent ITBS and/or CSAP test scores from your school, along with a copy of the most recent report card must be attached, and the teacher recommendation form must be received at Smiley in order for the application to be considered.

 

All pre-registration forms, test scores, report cards and teacher recommendations must be returned to the address below:

Smiley Middle School

Attn: IB MYP Pre-registration

2540 Holly St.

Denver, Co 80207

 

A math test and writing sample will be given and a mandatory interview will be conducted with the student and the parent/guardian.  Please call the office at 720-424-1540 to schedule dates.

The tests must be taken prior to interview date.

 

.

Office Use Only

 

ITBS Standardized Test                                CSAP Standardized Test                  Name of Standardized Test

Grade when taken: ____                                Grade when taken: ____                  Grade when taken: ______

____Reading Comprehension %                    ____Reading                                    _____Ravens

____Language Total %                                   ____Writing                                     _____COGAT

____Math Total %                                          ____Math                                         _____Other___________

____Composite %