Applicant Information
| Student Name: | Graves Jaxson | Date | April 2, 2017 |
|---|---|---|---|
| Sex | Male | Place of Birth | Washington,DC, United States |
| Email Address: | myishia.j@yahoo.com | Home Address | 2607 Reed St. NE Apt 223 WASHINGTON, District Of Columbia 20018 United States |
| Siblings | [] | ||
| Name | Grade | ||
| Religion: | Christian | Baptized: | NO |
| Local Public School System: | DC | Local Public School Child Would Attend: | Noyes Elementary School |
| Race of the Student: | Black | Ethnicity of Student: | Non-Hispanic |
Family Information
| Mother | Father | |
|---|---|---|
| Full Name | Myishia Jenkins | |
| Maiden Name | Myishia Jenkins | |
| Country of Birth | United States | |
| Home Address | 2607 Reed St. NE Apt. 223 | |
| Home Phone | (202) 629 8399 | |
| Mother Cell Phone | (202) 629 8399 | |
| Preferred Email | myishia.j@yahoo.com | myishia.j@yahoo.com |
| Mother Occupation | Vistor Information Assistant | |
| Employer | Arlington National Cementary | |
| Mother Work Phone | (703) 614 0344 | |
| Religion | Christian | |
| Parish/Church | Spirit of faith christian center |
| Parents’ Marital Status: | Married | Student lives with: | Mother and Father |
|---|---|---|---|
| Full Name | Myishia Juwanna Jenkins | Country of Birth | United States |
| Home Address | 2607 Reed St. NE Apt 223 | Preferred Email | myishia.j@yahoo.com |
| Home Phone | (202) 629 8399 | Cell Phone | |
| Occupation | Vistor Information Assistant | Employer | Arlington National Cementary |
| Work Phone | (703) 614 0344 | Religion | Christian |
| Parish/Church | Spirit of faith Christian Center | Person responsible for Tuition/Fee Payments: |
Myishia Jenkins |
| Address, City, State, ZIP: | 2607 Reed St. NE Apt 223 Washington DC 20018 | Phone & Email: | (202) 629 8399 |
Emergency Contact Information
| Contact #1: | Graves Maurice | Relation to Student: | Dad |
|---|---|---|---|
| Email Address: | gravesmaurice@yahoo.com | Home Address: | 2607 Reed St. NE Apt 223 WASHINGTON, District Of Columbia 20018 United States |
| Home Phone | (202) 415 1373 | Other Phone | |
| Contact #2 | Hooks Donnell | Relation to Student: | Brother |
| Email Address | don.nell3302@gmail.com | Home Address: | 1822 24th Street NE Apt. 204 Washington, District of Columbia 20002 United States |
| Other Phone | (202) 569 6531 | Home Phone | (202) 569 6531 |
Student Background Information
| Does your child need any particular academic enrichment in order to be successful in school? | NO |
|---|---|
| If yes, please explain briefly (other forms will be required): | |
| Has your child received special services from a professional (e.g. counselor, speech therapist, special education teacher)? | NO |
| Briefly describe the type of service, length of service, and if it discontinued, a reason for discontinuation: | |
| Does your child need accommodations to be successful in school? | NO |
| Please list: | |
| Does your child have any diagnosed allergies? | NO |
| If yes, please list (other forms will be required): | |
| Will your child require medication to be administered during the school day? | NO |
| If yes, please explain briefly (other forms will be required): | |
| Medical Diagnosis: Please check ✓ all that apply: | No known medical conditions |
| Physical Disability: | No existing physical disability |
| Learning Disorder: | No known learning disorder |
Home Language Survey
| Primary language(s) spoken in students household: | English |
|---|---|
| Does primary guardian speak English? | YES |
| Is the Student Bi-Lingual? | NO |
| Does the student spend significant time with a non-English speaking caregiver? | NO |
Transferring Students
| Is the student transferring from another school(s)? | YES |
|---|
| Dates Attended | School Name | City | Phone Number | Grade Avg |
|---|---|---|---|---|
| June 7, 2023 | St. Francis Xavier Catholic Academy | Washington DC 20020 | 202-581-2010 | KINDERGARDEN |
For Catholic Applicants Only
| Current Parish: | Spirit of Faith Christian Center | Pastor: | Mike Freeman |
|---|
| Date | Church | City | State | |
|---|---|---|---|---|
| Baptism | May 20, 2020 | Spirit of Faith Christian Center | Temple Hills | MD |
| Date Reconciliation: | ||||
| Date First Eucharist | ||||
| Date Confirmation | ||||
| Date Other | Date Other |
Parent/Guardian Acknowledgment
| ALL STUDENT APPLICANTS | |
|---|---|
| TRANSFER STUDENT APPLICANTS ONLY | |
| Mother Names of Parents/Guardians | Myishia Jenkins |
| Father Names of Parents/Guardians | Maurice Graves |
| Mother Signatures | Myishia Jenkins |
For Office Use Only
| Check ✓and Date when each item is received and verified |
|---|
| Applicant Name: |
| Application Received: |
| Application Fee Paid: |
| Baptismal Certificate: |
| Immunization Documents: |
| Birth Certificate: |
| If Applicable |
| Allergy Agreement :, |
| Custody Decree: , |
| Transfer Students ONLY: |
| Report Cards: , |
| Test Scores: , |
| Admissions Interview Completed: , |
| RELIGION: , |
| Catholic |
| Non-Catholic: |
| Parish Registration Form: , |
| STATUS: |
| Accepted: , |
| Denied: , |
| Grade:, |
| Homeroom Teacher: , : |
| Name: | Address: | ||
|---|---|---|---|
| Phone Number: | NOTES: |