Page 1

     

     

Grades 6 – 12 Admissions Application


Island Pacific Academy Where Creativity and Curiosity Burn Bright

Dear Parents and Students: Aloha! Thank you for your interest in Island Pacific Academy. Choosing a school can be an exciting process, and we look forward to helping you to discover all that Island Pacific Academy has to offer. The information included in this packet will answer many of your initial questions about our school and the admission process. We welcome you to schedule a tour of our campus while school is in session, to attend an Open House, and to visit our website at www.ipahawaii.org. As West Oahu’s largest independent, accredited, coeducational school, Island Pacific Academy enrolls students in Junior Kindergarten through Grade 12. The school offers an enriched and stimulating college preparatory program in a safe and nurturing environment. IPA graduates currently attend colleges and universities across the country and around the world. IPA is an International Baccalaureate (IB) World School, offering the Diploma Programme to high school students, and is a candidate for the Middle Years Programme (MYP) and Primary Years Programme (PYP). The internationally recognized IB curriculum develops inquiring, knowledgeable and caring individuals with a genuine concern for the world around them. “Small class sizes make learning accessible and emphasize knowing how to learn. We promote important life skills, such as critical thinking and problem-solving, within a values-based context,” shares Headmaster Dr. Daniel White. “Our goal is to graduate students whose performance matches their abilities, whose curiosity and creativity burn bright, and whose values reflect the virtues of human kindness and generosity of spirit.” Located in Kapolei on a modern campus with state-of-the-art classrooms and facilities, IPA attracts students from diverse backgrounds. Students benefit from a challenging academic curriculum and are able to explore their unique talents and interests through a wide array of choices in the arts, music, engineering and design, athletics, student activities, and community service. The admission process is designed to get to know each family and applicant well. To this end, the Admission Committee considers each individual’s personal strengths and abilities based on a review of the student’s academic record, admission testing results, teacher references, and interview. We seek to enroll students who will find academic and personal success in IPA’s program, who demonstrate respect and kindness toward others, and who are eager to contribute positively to the school community. While applying to an independent school may seem overwhelming at first, we are here to ensure that the admission process is as smooth and as stress-free as possible. If you have any questions or would like to schedule a campus tour, please contact the Admission Office at 808-674-3563. We look forward to meeting you! Sincerely,

Megan Meyer Director of Admissions

909 Haumea Street, Kapolei, Hawaii 96707

808-674-3563

www.ipahawaii.org


Island Pacific Academy

Admission Application Instructions Island Pacific Academy welcomes you as a candidate for admission. We encourage you to refer to the instructions below as a way to simplify the admission process. Please call the Admission Office at 808-674-3563 if you have questions.

All Applicants

□ □

Application Please return the completed Application for Admission, the non-refundable $65 application fee, a copy of the applicant’s birth certificate, and a recent photograph of the applicant to the Admission Office. Tour We encourage all prospective families and students to become familiar with Island Pacific Academy. We invite you to contact the Admission Office at 808-674-3563 to arrange a tour while school is in session. In addition, families may find it helpful to attend an Open House, to visit the school’s website at www.ipahawaii.org, and to read through the school’s literature to become better acquainted with IPA. Application Submission Timeline The application deadline for priority consideration is January 31. Parents are encouraged to submit applications as soon as possible so that we may schedule applicants for an admission assessment. Applications must be complete with all of the required supporting documents by February 15 to be considered for the first round of priority admission decisions. Applications received after this date will be considered on a rolling basis as long as vacancies exist.

Applicants to Junior Kindergarten and Kindergarten Age Requirements • Junior Kindergarten applicants must be 4 years old by June 30 (boys) or August 31 (girls). • Kindergarten applicants must be 5 years old by June 30 (boys) or August 31 (girls).

Teacher Reference Reports and Progress Reports Parents should complete the parents’ portion of the Teacher Reference Report and then give the form to your child’s current teacher. The teacher should send the completed form directly to the Admission Office by February 1. Parents may also submit a copy of your child’s pre-school progress report, if available. If your child is not currently enrolled in a pre-school program, these items are not required. Assessment Applicants to Junior Kindergarten and Kindergarten will be scheduled for an admission assessment. The focus of the assessment is to evaluate a child’s developmental maturity and school readiness for IPA’s program.

Applicants to Grades 1 – 5 Academic Records Please send copies of your child’s following academic records to the Admission Office by February 15. Parents may submit personal copies of the academic records indicated below or give the Consent for Release of Information form to your child’s current school to request that copies of these records be sent to the Admission Office at IPA. • A copy of the previous year’s final report card, including teacher’s comments, and a copy of the first semester report card for the current school year. • Copies of the most recent standardized test scores. (continued)

909 Haumea Street, Kapolei, HI 96707 ● 808-674-3563


Applicants to Grades 1 – 5 (continued)

□ □

Teacher Reference Report Parents should complete the parents’ portion of the Teacher Reference Report and then give the form to your child’s current teacher. The teacher should send the completed form directly to the Admission Office by February 1. Testing Applicants to Grades 1-5 will be scheduled to complete admission entrance testing at IPA.

Applicants to Grades 6-12

□ □

Student Questionnaire and Student Interview Students applying to Grades 6-12 must complete the Student Questionnaire. Applicants will be scheduled for a personal interview with a member of the Admission Committee. Academic Records Please send copies of your child’s academic records to the Admission Office by February 15. Parents may submit personal copies of the academic records indicated below or give the Consent for Release of Information form to your child’s current school to request that copies of these academic records be sent to the Admissions Office at IPA. • •

A copy of the previous year’s final report card, including teacher’s comments, and a copy of the first semester report card for the current school year. Copies of the most recent standardized test scores.

Teacher Reference Reports •

Applicants to Grades 6-8 (2 required) Parents should complete the parents’ portion of the Teacher Reference Reports and then distribute the forms to your child’s current mathematics and English teachers. If your child has only one teacher, give the second form to your child’s additional academic subject, coach, activity coordinator or previous year’s teacher. The References should be sent directly to the Admission Office by those completing the forms by February 1.

Applicants to Grades 9-12 (3 required) Parents should complete the parents’ portion of the Teacher Reference Reports and then distribute the forms to your child’s current mathematics and English teachers. Please give a third Teacher Reference Report to the teacher of an additional academic subject, coach, activity coordinator or previous year’s teacher. The References should be sent directly to the Admission Office by those completing the forms by February 1.

Testing Applicants to Grades 6-12 will be scheduled to complete admission entrance testing at IPA. Please note, SSAT test results may be substituted for the IPA admission entrance testing if the applicant is registered to take the SSAT for admission to another private school. Please note; IPA’s School Code is: 4182.

909 Haumea Street, Kapolei, HI 96707 ● 808-674-3563


Island Pacific Academy

                 

Application for Admission

Student Photo 

                    Please submit with: * Non‐Refundable Application Fee of $65.                             * Copy of Birth Certificate                 * Recent Photograph

Applicant Applying for Grade __________________________

School Year 20___ - 20___

Applicant’s Name __________________________________________________________________________ First

Middle

Last

Preferred Name

______________________________________________________________________ Birth Date

Birth Place

Citizenship

Has this student applied to Island Pacific Academy before?

Male

Female

Age

□ No □ Yes, When? _____________________

Parent Information

□ Father □ Stepfather □ Guardian

□ Mother □ Stepmother □ Guardian

Name (Mr., Dr., Col., etc.)

Name (Mrs., Dr., Col., etc.)

Mailing Address

Mailing Address

City

State

Home Phone

Cell Phone

Zip

City

State

Home Phone

Cell Phone

Email Address

Email Address

Occupation and Title

Occupation and Title

Zip

Employer

Work Phone

Employer

Work Phone

High School

College

High School

College

With whom is the applicant living? If parents live separately, do you desire correspondence to be mailed to each parent? □ Both

□ Mother □ Father

School Information Please list all of the schools attended by the applicant, beginning with the current school year. School Name

Address

Years Attended

Grades

School Name

Address

Years Attended

Grades

School Name

Address

Years Attended

Grades

Siblings of Applicant Sibling’s Name

Birth Date

School

Years Attended

Grades

Sibling’s Name

Birth Date

School

Years Attended

Grades

909 Haumea Street, Kapolei, Hawaii 96707 ● 808-674-3563


Application for Admission - continued

page 2

Relatives or friends who have attended Island Pacific Academy Name

Relationship

Years Attended

Name

Relationship

Years Attended

Referral We have been referred to Island Pacific Academy by:

Additional Information In order for us to get to know your child better, we ask that you respond to the following questions. We appreciate your time in completing this section. If you need additional space, please attach a separate sheet. Why would you like your child to attend Island Pacific Academy?

What do you consider to be your child’s academic and personal strengths?

Please list your child’s academic, athletic and extracurricular activities and interests.

Describe your child’s talents or achievements, either in or outside of school.

Are there any factors or special circumstances you would like to share with us that have had an impact on your child’s academic or social progress to date, such as health, learning challenges, or changes of home, school or family situation?

909 Haumea Street, Kapolei, Hawaii 96707 ● 808-674-3563


Application for Admission - continued

Has your child ever skipped or repeated a grade?

page 3

□ No □ Yes

If yes, which grade? ____________________

Has your child ever been subject to any serious disciplinary action, suspension, or expulsion from school? If yes, please explain.

At Island Pacific Academy, we believe that parent involvement and support of a child’s school are integral to the success for children of all ages, particularly in an independent school. How would you like to be involved in your child’s educational experience at IPA?

We welcome any additional comments about your child.

Signature We (I) certify that the information provided on this application is true and accurate. Parent’s or Legal Guardian’s Signature

Parent’s or Legal Guardian’s Signature

Date

Date

Return with non-refundable fee of $65 to:

Island Pacific Academy Admissions Office 909 Haumea Street Kapolei, Hawaii 96707

Telephone: 808-674-3563 Fax: 808-674-3575 Email: admissions@ipahawaii.org www.ipahawaii.org

Island Pacific Academy admits students of any race, color, gender, religion, or national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, religion, gender, national or ethnic origin in the administration of its educational policies, admission policies, financial aid and scholarship programs, and athletic or other school-administered programs.


Island Pacific Academy

Consent for Release of Information To the Parent or Guardian Please complete the form below and submit it to the registrar or school office personnel at your child’s current school. I, _________________________________________________, parent or legal guardian of (Name of Parent or Legal Guardian)

________________________________________________________________________, (Child’s Full Name)

hereby grant permission to ________________________________________________________________________ (Child’s Current School)

to release copies of my child’s educational records to Island Pacific Academy for admission purposes only. ______________________________________________________ Signature of Parent or Guardian

__________________ Date

To the Registrar The student named above is an applicant for admission to Island Pacific Academy. Please send copies of the following items to Island Pacific Academy. Thank you. •

Copies of transcripts, grades, or copies of report cards or progress reports from the current and previous school years only.

Copies of standardized test results, if applicable. Send to: Island Pacific Academy Director of Admission 909 Haumea Street Kapolei, Hawaii 96707

We thank you in advance for your assistance. Should you have any questions, please contact the Admission Office: Phone: 808-674-3563 Fax: 808-674-3575 Email: admissions@ipahawaii.org

909 Haumea Street, Kapolei, Hawaii 96707 ● 808-674-3563


Island Pacific Academy

Teacher Reference Report

To the Parent or Guardian • •

Please type or print the information requested on the first line of the reverse side of this form. Please complete and sign the statement of consent below prior to giving this form to your child’s teacher. The information on the Teacher Reference Report is strictly confidential and is used only for admission purposes. I hereby give my permission to release the information that is requested on the Teacher Reference Report regarding my child, Child’s Full Name

for the purpose of admission to Island Pacific Academy. Signature of Parent or Guardian

Date

For applicants to Grades 2 – 5 Please give a Teacher Reference Report to your child’s current teacher. For applicants to Grades 6 – 12 Please give a Teacher Reference Report to your child’s English and Math teachers. For applicants to Grades 9 – 12 Please also give a Teacher Reference Report to a third teacher of an academic subject, an athletic coach, or an activity director. Please provide each teacher with a stamped envelope addressed to: Island Pacific Academy Director of Admission 909 Haumea Street Kapolei, Hawaii 96707 This form should be mailed directly by the teacher to Island Pacific Academy.

To the Teacher We sincerely appreciate your willingness to complete the Teacher Reference Report for this student, who is an applicant for admission to Island Pacific Academy. Island Pacific Academy, an independent, coeducational school for students in Junior Kindergarten through Grade 12, offers a challenging college preparatory education in an enriched, nurturing environment. Your professional observations of this student are important to us, and are part of the criteria used in considering his/her application. Please know that any information you share will be held in strictest confidence. • • •

Please mail this evaluation directly to the Admission Office between December 1 and February 1. If you receive this form after the above dates, please return it as soon as possible. If you would like to add additional comments about the student, please attach a separate sheet. Should you have any questions, please contact Megan Meyer, Director of Admission, at 808-674-3567.

We thank you in advance for the help your comments will provide. 909 Haumea Street, Kapolei, Hawaii 96707 ● admissions@ipahawaii.org Phone: 808-674-3563 ● Fax: 808-674-3575


HAWAII ASSOCIATION OF INDEPENDENT SCHOOLS Common Teacher Reference Report – Grades 2 - 12 Applicant’s Name________________________________________________________________Grade Applying ________ Last

Class Level:

First

Middle

Accelerated ________ High ________ Average _________ Low __________ Heterogeneous ___________

Subject and/or Grade ___________________________________________________

Self-contained □ Yes

□ No

Please check ( √ ) the appropriate rating. N/A (not applicable) may be used in areas where there is insufficient information. Academic Qualities •

Motivation (effort, drive)

rare

moderate •

Ability to work alone needs help frequently

needs help occasionally

Home study habits never completes assignments

completes assignments

contributes when called on

• joins in readily •

has some difficulty

good •

Use of time

does more than expected

volunteers occasionally •

Ability to express ideas orally

works well

Participation in discussion

maximum •

exceptionally good •

poor

average •

Organization of work

excellent •

poor

average •

Follows direction needs much explanation

excellent •

needs occasional help

responds quickly

Personal Qualities •

Leadership potential a follower

• occasionally seeks opportunities

Classroom conduct poor

average

Cooperates with adults rarely

usually

relates poorly with others

fluctuating relationships with peers; generally happy person

rarely rarely

usually

rarely

usually

rarely rarely

always •

usually •

Uses suggestions or corrections

always •

Fulfills responsibilities

always •

Takes initiative

healthy self image; healthy peer relationships

usually •

Consideration of others

always

Ability to work in a group

excellent

Personal/social adjustment

natural leader

always •

usually

always

We appreciate additional observations about this applicant.

Print or Type Name _______________________________________ Signature ___________________________________ (Indicate: □ Teacher or □ Administrator )

School_____________________________________________ School Phone # ___________________ Date __________ All HAIS schools accept this common form. Check the reverse side for date that completed form is due.


Island Pacific Academy

Teacher Reference Report

To the Parent or Guardian • •

Please type or print the information requested on the first line of the reverse side of this form. Please complete and sign the statement of consent below prior to giving this form to your child’s teacher. The information on the Teacher Reference Report is strictly confidential and is used only for admission purposes. I hereby give my permission to release the information that is requested on the Teacher Reference Report regarding my child, Child’s Full Name

for the purpose of admission to Island Pacific Academy. Signature of Parent or Guardian

Date

For applicants to Grades 2 – 5 Please give a Teacher Reference Report to your child’s current teacher. For applicants to Grades 6 – 12 Please give a Teacher Reference Report to your child’s English and Math teachers. For applicants to Grades 9 – 12 Please also give a Teacher Reference Report to a third teacher of an academic subject, an athletic coach, or an activity director. Please provide each teacher with a stamped envelope addressed to: Island Pacific Academy Director of Admission 909 Haumea Street Kapolei, Hawaii 96707 This form should be mailed directly by the teacher to Island Pacific Academy.

To the Teacher We sincerely appreciate your willingness to complete the Teacher Reference Report for this student, who is an applicant for admission to Island Pacific Academy. Island Pacific Academy, an independent, coeducational school for students in Junior Kindergarten through Grade 12, offers a challenging college preparatory education in an enriched, nurturing environment. Your professional observations of this student are important to us, and are part of the criteria used in considering his/her application. Please know that any information you share will be held in strictest confidence. • • •

Please mail this evaluation directly to the Admission Office between December 1 and February 1. If you receive this form after the above dates, please return it as soon as possible. If you would like to add additional comments about the student, please attach a separate sheet. Should you have any questions, please contact Megan Meyer, Director of Admission, at 808-674-3567.

We thank you in advance for the help your comments will provide. 909 Haumea Street, Kapolei, Hawaii 96707 ● admissions@ipahawaii.org Phone: 808-674-3563 ● Fax: 808-674-3575


HAWAII ASSOCIATION OF INDEPENDENT SCHOOLS Common Teacher Reference Report – Grades 2 - 12 Applicant’s Name________________________________________________________________Grade Applying ________ Last

Class Level:

First

Middle

Accelerated ________ High ________ Average _________ Low __________ Heterogeneous ___________

Subject and/or Grade ___________________________________________________

Self-contained □ Yes

□ No

Please check ( √ ) the appropriate rating. N/A (not applicable) may be used in areas where there is insufficient information. Academic Qualities •

Motivation (effort, drive)

rare

moderate •

Ability to work alone needs help frequently

needs help occasionally

Home study habits never completes assignments

completes assignments

contributes when called on

• joins in readily •

has some difficulty

good •

Use of time

does more than expected

volunteers occasionally •

Ability to express ideas orally

works well

Participation in discussion

maximum •

exceptionally good •

poor

average •

Organization of work

excellent •

poor

average •

Follows direction needs much explanation

excellent •

needs occasional help

responds quickly

Personal Qualities •

Leadership potential a follower

• occasionally seeks opportunities

Classroom conduct poor

average

Cooperates with adults rarely

usually

relates poorly with others

fluctuating relationships with peers; generally happy person

rarely rarely

usually

rarely

usually

rarely rarely

always •

usually •

Uses suggestions or corrections

always •

Fulfills responsibilities

always •

Takes initiative

healthy self image; healthy peer relationships

usually •

Consideration of others

always

Ability to work in a group

excellent

Personal/social adjustment

natural leader

always •

usually

always

We appreciate additional observations about this applicant.

Print or Type Name _______________________________________ Signature ___________________________________ (Indicate: □ Teacher or □ Administrator )

School_____________________________________________ School Phone # ___________________ Date __________ All HAIS schools accept this common form. Check the reverse side for date that completed form is due.


Island Pacific Academy

Teacher Reference Report

To the Parent or Guardian • •

Please type or print the information requested on the first line of the reverse side of this form. Please complete and sign the statement of consent below prior to giving this form to your child’s teacher. The information on the Teacher Reference Report is strictly confidential and is used only for admission purposes. I hereby give my permission to release the information that is requested on the Teacher Reference Report regarding my child, Child’s Full Name

for the purpose of admission to Island Pacific Academy. Signature of Parent or Guardian

Date

For applicants to Grades 2 – 5 Please give a Teacher Reference Report to your child’s current teacher. For applicants to Grades 6 – 12 Please give a Teacher Reference Report to your child’s English and Math teachers. For applicants to Grades 9 – 12 Please also give a Teacher Reference Report to a third teacher of an academic subject, an athletic coach, or an activity director. Please provide each teacher with a stamped envelope addressed to: Island Pacific Academy Director of Admission 909 Haumea Street Kapolei, Hawaii 96707 This form should be mailed directly by the teacher to Island Pacific Academy.

To the Teacher We sincerely appreciate your willingness to complete the Teacher Reference Report for this student, who is an applicant for admission to Island Pacific Academy. Island Pacific Academy, an independent, coeducational school for students in Junior Kindergarten through Grade 12, offers a challenging college preparatory education in an enriched, nurturing environment. Your professional observations of this student are important to us, and are part of the criteria used in considering his/her application. Please know that any information you share will be held in strictest confidence. • • •

Please mail this evaluation directly to the Admission Office between December 1 and February 1. If you receive this form after the above dates, please return it as soon as possible. If you would like to add additional comments about the student, please attach a separate sheet. Should you have any questions, please contact Megan Meyer, Director of Admission, at 808-674-3567.

We thank you in advance for the help your comments will provide. 909 Haumea Street, Kapolei, Hawaii 96707 ● admissions@ipahawaii.org Phone: 808-674-3563 ● Fax: 808-674-3575


HAWAII ASSOCIATION OF INDEPENDENT SCHOOLS Common Teacher Reference Report – Grades 2 - 12 Applicant’s Name________________________________________________________________Grade Applying ________ Last

Class Level:

First

Middle

Accelerated ________ High ________ Average _________ Low __________ Heterogeneous ___________

Subject and/or Grade ___________________________________________________

Self-contained □ Yes

□ No

Please check ( √ ) the appropriate rating. N/A (not applicable) may be used in areas where there is insufficient information. Academic Qualities •

Motivation (effort, drive)

rare

moderate •

Ability to work alone needs help frequently

needs help occasionally

Home study habits never completes assignments

completes assignments

contributes when called on

• joins in readily •

has some difficulty

good •

Use of time

does more than expected

volunteers occasionally •

Ability to express ideas orally

works well

Participation in discussion

maximum •

exceptionally good •

poor

average •

Organization of work

excellent •

poor

average •

Follows direction needs much explanation

excellent •

needs occasional help

responds quickly

Personal Qualities •

Leadership potential a follower

• occasionally seeks opportunities

Classroom conduct poor

average

Cooperates with adults rarely

usually

relates poorly with others

fluctuating relationships with peers; generally happy person

rarely rarely

usually

rarely

usually

rarely rarely

always •

usually •

Uses suggestions or corrections

always •

Fulfills responsibilities

always •

Takes initiative

healthy self image; healthy peer relationships

usually •

Consideration of others

always

Ability to work in a group

excellent

Personal/social adjustment

natural leader

always •

usually

always

We appreciate additional observations about this applicant.

Print or Type Name _______________________________________ Signature ___________________________________ (Indicate: □ Teacher or □ Administrator )

School_____________________________________________ School Phone # ___________________ Date __________ All HAIS schools accept this common form. Check the reverse side for date that completed form is due.


Island Pacific Academy Student Questionnaire This questionnaire is required for applicants to Grades 6–12. This form should be completed by the student.

Your Full Name

Name You Prefer To Be Called

Applying For Grade

Current School

Additional Questions What is your favorite subject in school and why?

What is your most challenging subject in school and why?

Please describe your primary activities and interests in and out of school (for example, music, art, drama, clubs, sports, community service, student council, scouting, church, etc.). Activity

Accomplishments or Awards

Plan to pursue at IPA?

(continued)

909 Haumea Street, Kapolei, Hawaii 96707 ● 808-674-3563


Student Questionnaire - Continued Please recommend a book you have read recently, and tell why you enjoyed it.

Please describe your academic and personal strengths.

Please share with us what you might see as your weaknesses, and explain briefly why you feel they are weaknesses.

Why would you like to attend Island Pacific Academy?

Please share with us any additional information you would like us to know about you.

909 Haumea Street, Kapolei, Hawaii 96707 â—? 808-674-3563


Student Questionnaire - Continued

Student Essay

Please write about a significant experience you have had and how you were changed or influenced by that experience.  

909 Haumea Street, Kapolei, Hawaii 96707 ● 808-674-3563


Island Pacific Academy

IMPORTANT REMINDERS     

For families that are new to Island Pacific Academy, please complete and submit the following items to the Admissions Office prior to June 1. 1. If your child is coming from a school in the state of Hawaii, you must submit a copy of his/her current completed Health Form 14. You do not have to complete a new form or have a new physical. 2. Children coming from a mainland school or children who have not been previously enrolled in school in the state of Hawaii MUST have a physical exam within one year before the first entrance into school in Hawaii. A U.S. Licensed physician must perform the exam and complete a Hawaii State Form 14 (enclosed). The exam and Form 14 may be completed on the mainland prior to arrival, if it is more convenient. 3. Children must have a Tuberculosis (TB) clearance completed within one year before the first entrance into school in the state of Hawaii. The Tuberculin test (Mantoux) must be performed and read by a U.S. Licensed Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Practice Registered Nurse (APRN), Physician’s Assistant (PA), or The Hawaii Department of Health. The results of new tests must be read and cleared before the first day of school in August. This may be done at the same time the physical exam is performed. Students who have not completed these requirements will NOT be permitted to enter school until the requirements are met.

909 Haumea Street, Kapolei, Hawaii 96707 ● 808-674-3563


Department of Education

Student’s Health Record

Day

Year

/

/

/

/

/ / / / Date

Results (mm)

❑ ❑ ❑

Hearing Problems Heart Disease Hemophilia

Physician, APRN, PA, or Clinic

Chest X-Ray Location

Results

*OFFICE USE ONLY (Rev. 2010)

❑ ❑ ❑

Hypertension JRA Arthritis Rheumatic Heart

Varicella Immunity Secondary to Disease (DATE)

❑ ❑ ❑

Seizures Sickle Cell Anemia Skin Problems

❑ ❑ ❑

Vision Problem

/

/

/

/

/

/

See Results Below

Completed PPD Screening (Check if Yes)

Reviewed Immunization Record (Check if Yes)

Nutrition

Scoliosis

Provider’s Stamp or Printed Name

Provider’s Signature

Immunizations (Vaccines, Dates Given: Month/Day/Year) DTaP, DTP, DT, Tdap or Td

Type

Polio (IPV or OPV)

Type

Hib (Haemophilus influenzae type b ) Pneumococcal Conjugate

Dental Examination Dental Check-Up

Entry Date

Medical Status

Skin

Nervous System

Teeth

Nose

Throat

Ears

R. L. R. L.

Eyes

Vision Hearing

/ / / /

Entry Date

Student Address Label

/ / / /

Allergies:

Tuberculosis Examination Date Read

Elementary:

/ / / /

Physician’s Examination Code: N-Normal; A-Abnormal; C-Corrected; R-Receiving Care

Mantoux Test (Intradermal)

Date Given

Entry Date

(Father/Guardian)

Cancer/Leukemia Chronic Cough/Wheezing Diabetes

Blood Pressure

BMI

Weight

Height

Grade

Date

Preschool:

High:

(Mother/Guardian)

❑ ❑ ❑

❑ ❑

Intermediate/Middle: Entry Date

Please complete the following sections (CHECK IF YES) Allergy (type) Asthma Behavioral Problems

Male

Abdomen

Month

Parent’s Name

(Middle Initial)

Heart

Birthdate

(First)

Female

Extremities

(Last)

Lungs

Name

Hepatitis B

Date Date Type Date Type Date Type Date

MMR

Date

Hepatitis A

Date

Other Other

Type Date Type Date

Physician, APRN, PA or Clinic

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Varicella

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Health History Comments: Include Referrals and Reports. Recommendation for significant findings. (Please Print) Date

Signature & Title

STATE OF HAWAI‘I, DEPARTMENT OF EDUCATION, FORM 14, Rev. 4/10, RS 10-1369 (Rev. of RS 09-1051)

Date

Signature & Title


Islland Paciific Acaddemy

Head dmasteer’s Welcom W e

I Mua M Me Ka K Ha‘aheeo. Go Forward d with Coonfidence. Thesse words on the t crest of Issland Pacific Academy exxpress a hope we share forr children groowing up in the st 21 century. c I am m privileged too lead educattors, parents and studentss who have come together to build Islland Pacific Academy A (IPA A), West Oah hu’s largest in ndependent, accredited a coollege preparaatory school enrolling 650 students in n Junior Kind dergarten through Grade 12. IPA proovides studen nts with an academically a e challenging educational experience led byy talented, caring teacherss in a nurturiing and enricched learningg environmen nt. IPA is an Internaational Baccaalaureate (IB) World Schoool, offering the t Diplomaa Programmee to high schoool studeents, and is a candidate foor the Middlle Years Proggramme (MY YP) and Primaary Years Proogramme (PY YP). The internationaally recognizeed IB curriculum develops inquiring, knowledgeab k ble and caringg individualss with a genu uine concern for the world d around theem. At Issland Pacific Academy, we w have develooped a schoool culture fou unded upon specific s core values: v the power p of hum man kindness and a generoosity of spiritt. These valu ues are maniffest in a comm mon phrase used u among studeents: “When never you can n, help.” Wee want our sttudents to seee themselves as part of a larger l commu unity and instill i in them m the strong belief that th hey can and should makee a positive difference. Our aim is to graaduate curiou us and creativve students whose w perform mance match hes their abiliities and whoose valuees reflect the virtues of hu uman kindneess and generrosity of spirit. We are prroud to have IPA graduattes atten nding outstan nding collegees and univerrsities across the t country and a around the t globe. Islan nd Pacific Acaademy is accrredited by th he Western Association A off Schools and d Colleges (W WASC) and the t Haw waii Associatioon of Indepeendent Schoools (HAIS), and a is a mem mber of the National Assocciation of Independent Sch hools (NAIS). For us, acccreditation siggnifies a com mmitment to on-going sch hool improveement, a m is consisten nt with otherr outstandingg independen nt proceess of reflectiion and self-aassessment. Our program schoools on Oahu and we sharre with our peer schools a commitmen nt to the phillosophy of seervice to otheers. To enable e our stu udents to go forward with h confidence to realize their goals and d aspirations is i a noble and d wortthy aim. I weelcome you to t join with us u to achieve that aim thrrough Island Pacific Acad demy. Aloh ha,

Dr. Daniel D E. Wh hite, Headmaster

9099 Haumea Sttreet, Kapoleii, Hawaii 967707 ● 808-6774-3563


Island Pacific Academy Classes of 2010, 2011 and 2012 C • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

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American University  Arizona State University  Biola University  Boise State University  Boston University  Brigham Young University, Hawaii  Brigham Young University, Idaho  Brigham Young University, Provo  California State University, East Bay  California State University Monterey  Bay  Case Western Reserve University  Chaminade University, Hawaii  College of Saint Rose  Colorado School of Mines  Colorado State University  Creighton University  DePauw university  Dominican University of California  Drexel University  Eastern Oregon University  Embry‐Riddle Aeronautical University  Emmanuel College  Evergreen State University  Florida State College, Jacksonville  Florida Atlantic University  Fordham University  Full Sail University  George Fox University  George Washington University  Gonzaga University  Grinnell College  Hampton University  Harvey Mudd College  Hawaii Pacific University  Humboldt State University  International Christian University,  Japan  Kansas State University  King’s College, UK  Lewis University  Lewis and Clark University 

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Linfield College  Long Island University  Louisiana State University  Loyola Marymount University  Manhattan College  Marist College  Marquette University  Marymount Manhattan College  Menlo College  Midland University  New York University  Northern Arizona University  Northwestern University  Occidental College  Oberlin College  Oregon State University   Otis College of Arts & Design  Pacific University  Point Loma Nazarene College  Purchase College, State University  of  New York  Reed College  Rose Hulman Institute of Technology  Saint Louis University  San Diego State University  San Francisco State University  Santa Clara University  Sarah Lawrence College  School of the Art Institute of Chicago  Seattle Pacific University  Seattle University  Seattle University‐Nursing Program  Seton Hall University  Southern Virginia University  Southwestern Assembly of God  University  Southwestern Oregon Community  College  St. Bonaventure University  St. John's College  St. John’s University  Suffolk University  Texas A & M University 

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808-674-3563

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University of Aberdeen, UK  University of Arizona  University of California, Berkeley  University of California, Davis  University of California, Irvine  University of California, Los Angeles  University of California, San Diego  University of Chicago  University of Colorado, Colorado  Springs  University of Colorado, Boulder  University of Denver  University of Edinburgh, UK  University of Hawaii, Hilo  University of Hawaii, Manoa  University of Hawaii, West Oahu  University of Houston  University of the Incarnate Word  University of Kent, UK  University of Lancaster, UK  University of La Verne  University of Louisiana, Lafayette  University of Oregon  University of the Pacific  University of Portland  University of Puget Sound  University of Redlands  University of San Diego  University of San Francisco  University of Southern California  University of Washington  University of Wyoming  Valley State University  Valparaiso University  Vanderbilt University  Vanguard University  Washington State University  Western Washington University  Westmont College  Whittier College  Willamette University 

909 Haumea Street, Kapolei, Hawaii 96707

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www.ipahawaii.org


Island Pacific Academy Sports Offered for 2012-2013 (subject to change)

Sport

Team

Levels of Competition

Gender

Approx. Start Date

Fall Season Bowling Cheerleading Cross Country Football Kayak Sporter Air Riflery Tennis Volleyball Water Polo

IPA Pac-5 IPA Pac-5 Pac-5 IPA IPA IPA Pac-5

Varsity Intermediate, JV & Varsity Intermediate, JV & Varsity Intermediate & Varsity JV & Varsity JV & Varsity JV Intermediate, JV & Varsity Intermediate & Varsity

Boys & Girls Boys & Girls Boys & Girls Boys & Girls Boys & Girls Boys & Girls Boys & Girls Girls Boys

Aug 2012 Aug 2012 Aug 2012 Aug 2012 Aug 2012 Aug 2012 Aug 2012 Aug 2012 Aug 2012

Winter Season Basketball Basketball Diving Paddling Precision Air Riflery Soccer Soccer Soccer Swimming Tennis Wrestling Wrestling

IPA IPA IPA Pac-5 IPA Pac-5 WestPac Pac-5 IPA IPA Pac-5 Pac-5

Intermediate, JV & Varsity Intermediate & Varsity Intermediate, JV & Varsity JV & Varsity JV & Varsity Intermediate, JV & Varsity Intermediate JV & Varsity Intermediate, JV & Varsity Intermediate Intermediate, JV & Varsity Intermediate & Varsity

Boys Girls Boys & Girls Boys & Girls Boys & Girls Boys Girls Girls Boys & Girls Boys & Girls Boys Girls

Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012 Nov 2012

Spring Season Baseball Baseball Golf Judo Softball Tennis Track & Field Volleyball Water Polo

Pac-5 WestPac IPA Pac-5 WestPac Pac-5 IPA CT* Pac-5

Varsity Intermediate & JV Intermediate & Varsity Intermediate, JV & Varsity Intermediate & Varsity Varsity Intermediate, JV & Varsity JV Intermediate & Varsity

Boys Boys Boys & Girls Boys & Girls Girls Boys & Girls Boys & Girls Boys Girls

Feb 2013 Feb 2013 Feb 2013 Feb 2013 Feb 2013 Feb 2013 Feb 2013 Feb 2013 Feb 2013

Levels of Competition (Eligible Grades) Intermediate: Grades 7-9 JV: Grades 9-11 Varsity: Grades 9-12 (exception Football) *combined team with Hanalani Schools (host) (conditioning for some sports will take place prior to the start date)


Island Pacific Academy

Parent as Participant Active Involvement in Our School Island Pacific Academy is a non-profit organization relying solely on tuition and the generosity of others for its operating costs. Thus, the independent school community is an interdependent one in which many are needed to work for the success of the whole. Being a parent at IPA means taking advantage of the opportunities for involvement in the life of the school and taking responsibility for its support. Commitment to and active involvement in the school are expectations we have of each other and every member of our parent community. Responsibilities and opportunities for parents include: 1. Advocacy of children. Interest and involvement in the educational, moral and social growth of their children and the children of others; 2. Participation in volunteer support of the school. Giving time and talent to insure the success of school programs; 3. Financial support of the philanthropic endeavors of the school, helping IPA to bridge the gap between tuition income and operating expenses; 4. Advocacy of the school. Promoting the educational environment and program at IPA to others in the wider community.

Advocacy of Children Children learn best when they are challenged, encouraged and guided in age-appropriate ways in a nurturing and consistent atmosphere. Teachers and parents are the adults most responsible for creating and maintaining such an environment, and they do so dependent upon each other. Teachers know the curriculum, have the experience with many children over time, and continually educate themselves about brain research, teaching strategies and other professional concerns. Parents continuously define the atmosphere in which children grown and mature, know their children outside the classroom, and decide whether the learning environment at IPA is compatible with their children’s needs and talents. An equally important answer is that volunteering makes stronger the bond between family and school. We feel best when we feel needed, and when we are needed our commitment is greater. Volunteering is also wonderful rolemodeling for the students in our lives to whom we seek to impart the ethic of social involvement and responsibility. The IPA Parents’ Association (IPAPA) coordinates many of the volunteer activities. For all of us, finding time to volunteer is a major challenge. Yet supporting the education of our children with our volunteer time is worthwhile. The opportunities to contribute are many. The question faced by IPA parents is not, “Will I volunteer?” The question is “In what way will I volunteer?”

(continued) 909 Haumea Street, Kapolei, Hawaii ● 808-674-3563


Philanthropic Support At independent schools, tuition paid by parents typically covers 85% of the operating budget. The remainder is raised primarily through gifts and charitable donations. Parents are expected to give to the Annual Fund, and have other fund-raising opportunities to help meet the needs of the school. In return, the school pledges to be good stewards of parental gifts. The advantages of philanthropy over increased tuitions are evident. Gifts are tax-deductible, because we are a nonprofit school; tuitions are not. Gifts require an additional commitment by the giver to the school. Your gift is an investment; funding the budget each year insures the delivery of the program and provides other funding for such projects as faculty salary endowments, building campaigns, and the acquisition of technology and other resources that enrich the students’ growth and development. Numbers matter. IPA will approach outside foundations for financial support, as well. The first question these funders will ask is, “What percentage of your families gives to the school’s Annual Fund?” Thus, we will seek 100% parent participation and gratefully accept whatever size gift the giver can afford.

Advocacy of the School At Island Pacific Academy, you join other parents and their talented, motivated children to form a unique educational environment, which is renewed and enriched with each new family. At IPA we work diligently to earn and retain the confidence of our parent community as we seek to move each child to performance consistent with his or her ability and to develop the basic human values of kindness and generosity of spirit. As our success grows, we welcome advocacy on behalf of the school by parents. The sharing of experience by parents and students is our most effective way to excite others to investigate our program. We seek students who are motivated to learn and able to benefit from our program, students from families that fully support their children’s education with their time, their talent and their resources. When these elements are combined with a creative, nurturing and challenging faculty, an excellent school results. We aspire to nothing less. We count on you to take the opportunity to share the story of Island Pacific Academy with those you know.               909 Haumea Street, Kapolei, Hawaii ● 808-674-3563 


Island Pacific Academy

Tuition and Expenses Tuition and Fees

Additional Expenses

Tuition for the 2012-2013 school year: • Elementary School (JK – Grade 5): $14,000

Lunch and Extended Day Care are not covered by tuition. Students may bring lunch from home or elect to order lunch at an additional cost. IPA offers a convenient before and after school extended care program on-campus for an additional fee.

Middle School (Grades 6 – 8): $15,300

Upper School (Grades 9 – 12): $16,000

Tuition information for the 2013-2014 school year will be available in January 2013. Upon acceptance, a $550 deposit is required to hold a student’s place for the upcoming school year. The deposit is applied toward the total tuition cost, and is non-refundable for new students after April 15 (Grades 6 – 12) or May 10 (Junior Kindergarten - Grade 5) in accordance with the HAIS common reply dates.

Tuition Payment Options There are two payment options for IPA families. •

Payment in Full. All tuition is paid by July 1, before the school year begins.

The Monthly Payment Plan. Families can elect to pay tuition in 12 equal installments from June through May. Monthly payments are made through the FACTS Tuition Management program by automatic withdrawal through a bank account. There is a $41 annual fee to set up an account with FACTS. Families who opt for the monthly payment plan are also required to participate in the Tuition Refund Plan.

Tuition Refund Plan Because the financial commitment of enrollment is for an entire year, IPA offers a Tuition Refund Plan. The cost of the Tuition Refund Plan is approximately three percent of the total tuition. The Plan enables parents to insure themselves against full liability for unused tuition due to student withdrawal, dismissal, or extended medical absence. Participation in the Tuition Refund Plan is required for families who choose the Monthly Payment Plan and is optional for those families who pay the full tuition by July 1.

Students at IPA purchase school supplies and school uniforms. The average cost for school supplies is approximately $100, but varies depending on the grade level. The cost for one week’s uniform outfits ranges from approximately $200-$300. Secondary students (Grades 6-12) purchase textbooks. The cost for books varies depending on the grade level and course selection. Secondary students also bring their own portable laptops to school. Families may incur some additional fees and expenses, depending on the grade level, which include but are not limited to: class trips, dances, and athletics. In some cases, fundraising may be done to help offset the cost of certain activities. Information about additional expenses is available through the Admissions Office.

Financial Aid IPA is committed to offering need-based financial aid to qualifying students who have demonstrated economic need and maintain satisfactory academic and citizenship records. Financial need is determined by considering many factors including income, net worth, standard cost of living, family size, the number of children attending tuition-charging schools, and other factors. Because IPA’s financial aid budget is limited, grants are made at the discretion of the Financial Aid Committee within the constraints of the school’s financial aid budget. Approximately 20% of IPA’s students receive tuition assistance, with individual awards averaging about $5,000. IPA does not offer merit based scholarships or make financial aid awards covering 100% of the total tuition. Parents are encouraged to consider all possible financial resources available to them as IPA is unable to meet the need of every student who qualifies for aid. For more information about financial aid, fill out the enclosed Request for Information and return to the Admissions Office by January 15, 2013.

909 Haumea Street, Kapolei, HI 96707 ● 808-674-3563

Grades 6-12, Admissions Application  
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