Sutton Scholars® High School Enrichment Program - New Application Header Image

Application Instructions and Information for New Prospective Scholars 

Last Day Applications Accepted:  March 31, 2024

Please read through all of the instructions and information prior to starting your application.

 

1. The application must be completed in full prior to final submission. The system will not accept incomplete applications. This application is for NEW prospective scholars only.

2. There is a “Save and Resume” option as you progress through the application. If you are unable to complete the application at any point, simply save your progress and exit. When you are ready to resume completing the application, you will be taken back to your last save point when you re-access the application. An email will be sent to you with a link to re-access your application after you have saved and exited.

PLEASE NOTE: Do not upload any forms, letters of recommendation or sign forms when using "Save and Resume". Uploaded material will NOT be saved to the form until the form is ready for FINAL SUBMISSION. Users should not upload files or sign the forms until they are ready to submit.

3. ALL prospective scholars MUST PROVIDE PROOF OF COVID-19 VACCINATION.  A copy of your proof of vaccination must be submitted with your application.  All vaccination records must be brought for visual review on the first day of the program.  

4.  All information submitted in your application is held in the strictest confidence.

5. Some questions may seem insensitive or intrusive and personal. The Sutton Scholars program is the recipient of many sources of grants and as such, we are required to maintain certain information on all types of demographics, to include economic and sociological information. Your personal information is NEVER used or shared. We only use information for statistical purposes as requested by our funders.  We could not operate the Sutton Scholars program without these funding opportunities, so we ask for your understanding about why we ask certain/particular questions. 

6. The required 500-word essay and letters of recommendation must be uploaded during the application process, but NO documents should be uploaded until you are ready to submit the entire application. Using the Save and Resume function on this application does not save uploads. You can also type your essay directly into the application if this is easiest for you, however; recommendation letters must be uploaded. All recommendation letters must be signed by the individual providing the recommendation.

7.  If you take medications prescribed by a physician, you must have form MDH-4758 filled out and signed by your doctor and submitted no later than June 20, 2022. There is a link for the form in the application.



If you have any questions or concerns, please do not hesitate to contact the Rev. Neva Brown, director of community engagement, nbrown@suttonscholars.org or call 410-274-0557.

Sutton Scholar Agreement

As a new Sutton Scholar, I agree to fully participate in the Sutton Scholars High School Enrichment Program activities and curriculum and adhere to the following:


1.  I understand and agree that I am participating in a six-week summer program to support my success in high school and beyond.  As well, I understand and agree to participate in all scheduled activities during the school year to support my continued development as a successful scholar and high school student.

2.  I understand and agree that I am expected to participate in group discussions and activities on a daily basis.

3.  I understand and agree that I am expected to ask for help with any problem areas that I may encounter.

4.  I understand and agree that I will always conduct myself in a courteous and responsible manner.

5.  I understand and agree that honesty and integrity are the most important qualities that I must demonstrate.

6.  I understand and agree that no weapons, alcohol, illegal substances, physical altercations or sexual misconduct will be tolerated.  Violation of any of these can result in my immediate termination from the program.

7.   I understand and agree that I am expected to respect all teachers, aides, other assigned staff and adult supervisors.  

8.   I understand and agree that the use of foul or inappropriate language and cursing will not be tolerated.

9.  I understand and agree that I must wear a Sutton Scholars t-shirt and/or polo shirt on a daily basis.

10.  I understand and agree that the use of my phone and other electronic devices during program hours may be limited and/or prohibited.  


Both you and your parent/guardian must sign in the following signature boxes to indicate that you have read and understood the Sutton Scholar Agreement.





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Section One: Scholar Information

Name:*
Address:*
Date of Birth*
Scholar Demographic Information - Please Check One:*
Gender:*
Are you bilinqual?*
Is anyone in your immediate family currently an active military service member or veteran?*
Do you have a disability? *
Do you identify as LGBTQIA?*
What are your preferred pronouns:*
T-shirt size*

Section Two: Educational Information

Address*

Essay

The essay serves as an example of how you express your views and ideas.  Please select one of the following statements to discuss in your essay:

1.  Select two (2) skills you think are important to successful? In writing, discuss how these skills will make you successful in high school and beyond.

2.  Think of a time when you disagreed with someone.  In writing, explain if and how you resolved the disagreement.  What if the situation happens again?  Would you handle this situation differently? 

3.  After reading the material about the Sutton Scholars Program, what are the two (2) important things you hope to learn from your six-week experience with The Sutton Scholars Enrichment Program?  Why are these skills important to being successful?



Section Three: Parent / Guardian Contact Information

Name of Mother or Father or Guardian*
Name of Mother or Father or Guardian*
Emergency Contact #1 (Must be an individual over 18 years of age.) *
Emergency Contact #2 (Must be an individual over 18 years of age.) *
Parent / Guardian demographic information - Please Check One: *
Is parent / guardian bilingual? *
Is parent / guardian or anyone else in your immediate family currently an active military service member or veteran? *
Does parent / guardian have a disability? *
Does parent / guardian identify as LGBTQIA? *
Has parent / guardian's household been affected by incarceration? *
Has parent / guardian's household been affected by substance abuse? *
Marital Status*
Is your child eligible for free or reduced lunch?*
Annual Household Income: Please select one*
Is this a single parent household?*

Health Information From

Scholar's Full Name*
Parent / Guardian Name*
Scholar's Date of Birth*
Gender*
Emergency Contact #1 (If the Emergency Contact is the same as answered previously, you still must include the information here.)*
Emergency Contact #2 (If the Emergency Contact is the same as answered previously, you still must include the information here.) *
Primary Insured *
File
No File Chosen
File uploads may not work on some mobile devices.
Allergies*
General Health Information*
General Health Information
  Yes No
AIDS/HIV
Asthma
ADD/ADHD
Cancer/Leukemia
Convulsion/Seizures
COVID-19
Eyes/Ears/Nose/Throat
Diabetes
Digestion
Heart Trouble
Hemophilia
High Blood Pressure
Kidney Disease
Lungs
Mental Illness
Daily Prescriptions: If scholar takes any prescription medications (please list them below), a MDH-4758 form is required to be completed by the prescribing physician. All MDH-4758 forms must be submitted no later than June 20, 2022.
If yes, please provide prescribed medications in the box below)
General Health Information - Continued*
General Health Information - Continued
  Yes No
May we administer non-prescription meds (check list below)?
Does scholar have a history of seizures?
Does scholar have any special medical equipment (braces, glasses, etc)?
Does scholar have a current tetanus shot?
Date of Tetanus Shot, if Yes
Which over-the-counter medications may be administered?*
Which over-the-counter medications may be administered?
  Yes No
Antibiotic Ointment
Antifungal Cream
Caladryl Lotion (itch)
Benadryl Cream
First Aid Cream
Ear Drops (swimmer’s ear)
Hydrocortisone Cream
Antiseptic Wash
Eye Wash
Tylenol
Motrin/Advil
Benadryl
Sudafed
Pepto Bismol
Milk of Magnesia
Tums/Maalox
Throat Lozenges/Spray
Is Scholar prone to the following?*
Is Scholar prone to the following?
  Yes No
Headaches
Stomach Aches
Sore Throats
Sprains
Sunburn
Nightmares
Poison Ivy
Swimmer's Ear
Colds/Fever
Nose Bleeds
Menstrual Cramps

In case of emergency, I understand every effort will be made to contact me or either of the emergency contacts I have provided. In the event I or the designated emergency contacts cannot be reached, I hereby give my permission for the Sutton Scholar's Program, the Claggett Center, the Center’s designee, or the Episcopal Diocese of Maryland to secure proper treatment for the person named on this form, including hospitalization, surgery, anesthesia, or the administration of any medication oral or injected.  I understand and agree that I am responsible for all costs associated with any treatments that may be required.

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Date*

All medications must be checked in with the Sutton Scholar's Program Coordinator and/or medical staff.

All medications must be in their ORIGINAL containers with the Scholar's name and the dosage clearly visible. 

Medications will only be administered as per the directions on the prescription container.

An MDH-4758 form is required to be completed by the prescribing physician and clearly list all medications prescribed. All MDH-4758 forms must be submitted no later than June 20, 2022.


 


If NONE, write "NONE" in box.

MEDICATION ADMINISTRATION AUTHORIZATION FORM for Youth Camps in Maryland / MDH-4758-A


If your child will be taking prescription medication during the program, you must have their doctor complete the attached form. Download Form MDH-4758-A here. Once completed and signed by child's doctor, scan and upload the document below.


PLEASE NOTE: Do not upload any forms, letters of recommendation or sign forms when using "Save and Resume". Uploaded material will NOT be saved to the form until the form is ready for FINAL SUBMISSION. Users should not upload files or sign the forms until they are ready to submit.

Mandatory Releases

Scholar's Full Name*

Activity Release Statement 


During our program, Sutton Scholars participants will have the opportunity to participate in various activities that are both on and off the campus of Mercy High School.


I understand that sometimes participants will be transported by bus to activities off campus by certified drivers with a contracted bus company. I authorize my child's participation in these activities.


I acknowledge that my child's participation in activities while attending Sutton Scholars at Mercy High School requires following the rules of behavior in the classroom and other locations on campus. While rules, equipment, and personal discipline may reduce the risk, the possibility of serious injury is always possible.  I understand that such risks cannot be eliminated without jeopardizing the essential qualities of the activities.


On behalf of my child, I expressly agree and promise to accept and assume all the risks existing in these activities. I recognize that my child's participation in these activities is purely voluntary and I authorize his or her participation despite the risks.


I certify that I have adequate insurance to cover treatment of any injury suffered by my child while participating in physical/adventure activities or else I agree to bear the costs of such injury myself.


By signing below, I hereby voluntarily release Sutton Scholars®, its agent lessees, owners, officer volunteers, participants, employees and other persons or entities acting in any capacity on its behalf from all claims, demands, or causes of action that are in any way connected with my/my minor child's participation in adventure activities.

       
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Photo/Video Release


I give my consent for the Sutton Scholars Summer Enrichment Program to post pictures of me or my child on its website, Facebook and/or other social media platforms; printed materials for the purpose of promoting, marketing and/or advertising the Sutton Scholars Summer Enrichment Program.  I further consent to my child participating in video/filming during the course of activities and programs.

       
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Letters of Recommendation

Three (3) Letters of Recommendation are required. One (1) recommendation MUST come from a teach with direct knowledge of the student's abilities. The other two (2) recommendations may come from a counselor, minister, civic/community leader, coach, or an adult family friend (not parent or guardian).  Returning scholars do not need to provide letters of recommendation.

All recommendations should speak to the following attributes of the prospective scholar:

a.  Cooperative:  Follows class policies; participates and accepts work willingly.

b.  Dependable: Completes assigned tasks on time; works without close supervision.

c.  Initiative: Acts on things which need to be done and uses time effectively.

d.  Positive Attitude: Accepts constructive criticism; communicates effectively.

e.  Responsible: Takes ownership for own actions; demonstrates honesty; comes prepared to work.

PLEASE NOTE: Do not upload any forms, letters of recommendation or sign forms when using "Save and Resume".  Uploaded material will NOT be saved to the form until the form is ready for FINAL SUBMISSION. Users should not upload files or sign the forms until they are ready to submit.

Upload COVID-19 vaccination card*
No File Chosen
File uploads may not work on some mobile devices.
Letter of Recommendation #1*
No File Chosen
File uploads may not work on some mobile devices.
Letter of Recommendation #2*
No File Chosen
File uploads may not work on some mobile devices.
Letter of Recommendation #3*
No File Chosen
File uploads may not work on some mobile devices.
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