Please indicate field: Academic Fine Arts Tech/Career Ed Agricultural Ed

Georgia Department of Education

2012 Georgia Governor's Honors Program Student Nomination Form, Part 1

Subject Area: Biology If the area is music, include instrument or vocal part. Click to select part

Part 1 - This section is to be completed by the Student and Parent or Legal Guardian.
Directions: All information on this application must be completed on a computer.
Name of School System or Private School

Cobb County Public Schools

Name of School

South Cobb High School

Nominees Full Name

Muaaz Karim Choudhary

Home Address (Street/Route/Post Office Box)

2491 Arbor Walk Court

Home Phone (770) 529-4916 Birth Date (M/D/YY) 1/10/1995 Age 16 Grade 11 Gender Male

City

State

Zip

Acworth
Email Muaaz Choudhary

GA

30101

Fathers Full Name or Legal Guardian (With Title: i.e., Mr., Dr., Rev., etc.)

Mr. Zahid Karim Choudhary

Home Address (Street/Route/Post Office Box) (Write SAME if same address) City

2491 Arbor Walk Court

Business Phone Cellular Phone Email (770) 634-0688 (770) 634-0688 kishwarc@yahoo.com Mothers Full Name or Legal Guardian (With Title: i.e., Ms., Dr., Rev., etc.)

Acworth

Home Phone (770) 529-4916 Zip State GA 30101

Mrs.Kishwar Sultana Choudhary

Home Address (Street/Route/Post Office Box) (Write SAME if same address) City

2491 Arbor Walk Court

Business Phone (770) 928-1388 Cellular Phone (770) 634-5103 Email

Acworth kishwarc@yahoo.com

Home Phone (770) 529-4916 Zip State GA 30101

The interview teams will consider carefully the information given below in evaluating this nomination form. Be thorough in your answers. Please note that the textboxes will expand as you type. 1. Describe your interest in your nomination area. To begin with biology, the study of life, has always intrigued me. Biology shows how we operate in order to survive. It also illustrates how humans and other animals interact. Biology is also a changing field because new research can shed new light on topics we never fully understood. I personally love a changing field because I love subjects that never get boring. These and many other reasons have made biology a subject that will always interest me. 2. What have you already accomplished in your nomination area beyond regular classroom work? (Submit evidence as required in the Instructional Descriptions and Criteria for Selection guidelines. Check with your local GHP coordinator for this information. Please consider that the evidence submitted will not be returned. Duplicate copies will suffice). I have received many accomplishments beyong regular work. First, I took AP Biology as a sophomore while other students take this class as juniors or seniors. I was also accepted into a Kennesaw State University program, and this summer I plan to apply to P.A.V.E. (program offered by Vanderbilt). I have also recieved an A in both of my biology classes. 3. Why do you feel that you should be selected as a Finalist?

As stated before biology has been a major aspect of my personal and academic life. I have a passion to read new research about anything in biology. I would love to be a finalist and talk with other students that share the same interests me.

4. Have you decided on a career? If so, tell about it. Yes, I plan to receive my M.D and go into a field of residency which is undecided. I am doing this because biology intrigues me and in order to be a passionate doctor you have to understand and love biology 5. Make any statement in support of your nomination, which you think has not been covered elsewhere on this form. Well my love for biology has grown over the years thanks to the different levels of biology classes. I would love to learn more and work with other like minded students. I cannot even begin to show how passionate I am about biology.

Students and Parents: Read carefully before signing the following statements.
Student Signature Area Conditions I understand that in addition to this application, and to remain eligible for selection in the 2012 Governors Honors Program, I must appear at, and participate in, the statewide interviews, as scheduled by the Georgia Department of Education.

2012 Governors Honors Program Interview Dates and Locations

Dance and Theatre Saturday, January 28, 2012 Pebblebrook High School in Mableton, Georgia Communicative Arts, Biology, Chemistry, Physics, and Social Studies Saturday, January 28, 2012 Luella High School in Locust Grove, Georgia Music and Visual Arts Saturday, February 4, 2012 Pebblebrook High School in Mableton, Georgia Foreign Languages, Mathematics, and Technology/Career Education Saturday, February 4, 2012 Luella High School in Locust Grove, Georgia Agricultural Education Saturday, February 4, 2012 The University of Georgia (Athens) If selected to attend the program, I agree to participate in all scheduled activities including special events and seminars. I understand that I must concentrate in one major area of study, that I cannot change my major area, and that I will select a minor area of study (chosen during the first week of the program). I understand that the program will be a four-week residential program and that I am expected to remain in the program for the entire period (June 24 July 21, 2012) without interruption. I will arrive on the opening day no later than 2:00 PM and will leave no earlier than 11:00 AM on the closing day of the program. I understand that no exceptions will be made to this attendance requirement, and that my inability to meet it will result in immediate dismissal from the program. I understand that all information regarding the GHP selection process and finalist participation is available on the GHP Web Page, and that it is my responsibility to remain informed of updates by accessing the GHP web site at:

http://snipurl.com/ghp_doe
Date (M/D/YY) Nominees Signature (Required)

Parent/legal guardian signature area

My child has my permission to participate in the 2012 Governor's Honors Program. We have read and agree to the above conditions. We further agree for the school to release his/her school records in support of his/her nomination. If my child is chosen as a finalist, I give permission for the Georgia Department of Education to release his/her name and school of attendance to the public.
Date (M/D/YY) Name of Parent or Legal Guardian

Signature of Parent or Legal Guardian (Required)

Please indicate field: Academic Fine Arts Tech/Career Ed Agricultural Ed

Georgia Department of Education

2012 Georgia Governor's Honors Program Student Nomination Form, Part 2

Subject Area: Click to select area If the area is music, include instrument or vocal part. Click to select part

Part 2 - This section is to be completed by the Nominating Teacher.

Directions: All information on this application must be completed on a computer.
Name of School System or Private School

Cobb County Public Schools

Nominating Teachers Name

Nominees Full Name

NOTE: Parents and student may (under PL 93-380) review your evaluations. This evaluation should not be considered confidential.

The interview teams will consider carefully the information given below in evaluating the student. Be thorough in your answers. Please note that the textboxes will expand as you type. 1. How has this student demonstrated outstanding abilities and achievement in your classroom? 2. What evidence do you have of the student's attitude toward independent and self-directed learning beyond the regular classroom experience? (Do not list awards or honors as they are requested elsewhere on this form.) 3. What assurances do you have of the student's personal commitment to study in the area of his or her nomination? 4. Other Comments. 5. List awards and honors won by the student in grades 9-11 in area of nomination. Please be specific. 6. List courses taught to the nominee by the nominating teacher. Course Title

Quarter/Semester/Year

I recommend this student for participation in the 2012 Governor's Honors Program.

Date (M/D/YY)

Nominating Teachers Name Signature (Required)

Please indicate field: Academic

Georgia Department of Education

Subject Area: Click to select area

Fine Arts Tech/Career Ed Agricultural Ed

2012 Georgia Governor's Honors Program Student Nomination Form, Part 3

If the area is music, include instrument or vocal part. Click to select part

Part 3 - This section is to be completed by the local system GHP Coordinator.

Directions: All information on this application must be completed on a computer.
Name of School System or Private School School Attending

Cobb County Public Schools

School Address (Street/Route/Post Office Box)

City

School Phone () - County Zip

Nominees First Name Middle Name

Last Name

Preferred Name

Email

Yes No

This section MUST be completed if nominee is enrolled in a home school program: Parent has completed the GHP Home School Student Eligibility Verification Form (must be attached to this form) : Student is compliant with Georgias Home Study Law, OCGA 20-2-690: Yes No

List courses taken in area of nomination. Indicate each course by Course title; Time: Semester (S), Quarter (Q), or Year (Y); and Level of Instruction: Accelerated (Acc), Advanced (Adv), or Regular (R). Indicate if Block Scheduling (B).
Course Title Overall Numeric Average Overall Grade Point Average Time (S,Q,Y)/(B) Area of Nomination Numeric Average Area of Nomination Grade Point Average Level of Instruction

List date(s) PSAT/SAT was taken. A printout (or clear photocopy) of the score sticker or score report from testing service showing PSAT/SAT scores must be attached as the final page of this nomination form/packet, or brought to the statewide interviews.
Date (M/D/YY) Date (M/D/YY) Date (M/D/YY) Date (M/D/YY)

The interview teams will consider carefully the information given below in evaluating the student. Be thorough in your answers. Please note that the textboxes will expand as you type. List awards and honors won by the student in grades 9-11 in areas other than the Area of Nomination. Please be specific. List extracurricular activities of student in grades 9-11.

I support the nomination of this student for the 2012 Governors Honors Program.
Date (M/D/YY) Date (M/D/YY) Date (M/D/YY) Counselors Name

Principals Name

Counselors Signature (Required) Principals Signature (Required) Superintendents/Headmasters Signature (Required)

Superintendents/Headmasters Name

Dr. Michael Hinojosa I support the nomination of this student for the 2012 Governors Honors Program and I have checked ALL application materials for accuracy and required signatures. I understand, and have notified the student of required dates for interviews and program participation. I understand that all information regarding the GHP selection process and finalist participation is available on the GHP Web Page for my nominees, and that it is my responsibility to keep them informed of updates by directing them to access the web site at:

http://snipurl.com/ghp_doe
Date (M/D/YY) Local Coordinators Name Coordinators Phone Number () - Local Coordinators Signature (Required) Email

Return one complete copy to Mr. Dale Lyles, Director, Governors Honors Program, 1870 Twin Towers East, Atlanta, GA 30334-5040. Be sure that official school transcripts appear after this page, and PSAT/SAT scores are attached as the final page of this form.

Please retain for your records one copy of each completed student application.