Applicant Information
| Student Name: | Whitaker Andres | Date | December 24, 2018 |
|---|---|---|---|
| Sex | Male | Place of Birth | FPO,11, United States |
| Email Address: | TEAMDEWHIT@GMAIL.COM | Home Address | PSC 558 Box 4466 FPO, AP 96375 United States |
| Siblings | [] | ||
| Name | Grade | ||
| Religion: | Catholic | Baptized: | YES |
| Local Public School System: | Maehara Catholic Montessori School | Local Public School Child Would Attend: | na- Moving from Japan |
| Race of the Student: | Black | Ethnicity of Student: | Hispanic |
Family Information
| Mother | Father | |
|---|---|---|
| Full Name | Julia Whitaker | Terry Whitalelr |
| Maiden Name | Garcia | |
| Country of Birth | USA | USA |
| Home Address | PSC 558 Box 4466 | PSC 558 Box 4466 |
| Home Phone | ||
| Mother Cell Phone | (704) 891 8212 | (229) 449 6539 |
| Preferred Email | teamdewhit@gmail.com | teamdewhit@gmail.com |
| Mother Occupation | Nurse Practitioner | Lt COL |
| Employer | na | United States Marine Corps |
| Mother Work Phone | (704) 891 8212 | (704) 891 8212 |
| Religion | Catholic | Protestant |
| Parish/Church | Camp Foster Chapel | Camp Foster Chapel |
| Parents’ Marital Status: | Married | Student lives with: | Mother and Father |
|---|---|---|---|
| Full Name | Terry and Julia Whitaker | Country of Birth | United States |
| Home Address | PSC 558 Box 4466 | Preferred Email | teamdewhit@gmail.com |
| Home Phone | Cell Phone | (229) 449 6539 | |
| Occupation | Lt Col | Employer | United States Marine Corps |
| Work Phone | (704) 891 8212 | Religion | Catholic/ Protestant |
| Parish/Church | Camp Foster Chapel | Person responsible for Tuition/Fee Payments: |
Terry Whitaker |
| Address, City, State, ZIP: | PSC 558 BOX 4466 FPO, AP 96375 | Phone & Email: | (704) 891 8212 |
Emergency Contact Information
| Contact #1: | Muhammad Rabb | Relation to Student: | Family Friend |
|---|---|---|---|
| Email Address: | romuhammad@gmail.com | Home Address: | 1309 E Street SE #38 Washington, dc 20003 United States |
| Home Phone | (404) 429 9740 | Other Phone | |
| Contact #2 | Muhammad Donique | Relation to Student: | Family Friend |
| Email Address | doniquenobles@gmail.com | Home Address: | 1309 E Street SE #38 Washington, DC 20003 United States |
| Other Phone | (662) 312 7003 | Home Phone |
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)? | YES |
| Briefly describe the type of service, length of service, and if it discontinued, a reason for discontinuation: |
Speech therapy related to a tongue tie |
| 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: | Identified Disorder (specify): |
Home Language Survey
| Primary language(s) spoken in students household: | |
|---|---|
| Does primary guardian speak English? | YES |
| Is the Student Bi-Lingual? | NO |
| Does the student spend significant time with a non-English speaking caregiver? | YES |
Transferring Students
| Is the student transferring from another school(s)? | YES |
|---|
| Dates Attended | School Name | City | Phone Number | Grade Avg |
|---|---|---|---|---|
| April 10, 2023 | Maehara Catholic Montessori School | Okinawa, Japan | +81 098-897-9387 |
For Catholic Applicants Only
| Current Parish: | Camp Foster Chapel | Pastor: | Fr. O’Malley |
|---|
| Date | Church | City | State | |
|---|---|---|---|---|
| Baptism | August 11, 2019 | |||
| Date Reconciliation: | ||||
| Date First Eucharist | ||||
| Date Confirmation | ||||
| Date Other | Date Other |
Parent/Guardian Acknowledgment
| ALL STUDENT APPLICANTS | Non-Refundable Application Fee of $375.00, Copy of Valid Age Birth Certificate, Archdiocese of Washington Immunization Policy, Acknowledgment and All Attachments(Required for Admission), Copy of Baptismal Certificate (Catholics only), Allergy Action Plan (If Applicable), Copy of custody order, or other applicable court orders (If Applicable), All relevant evaluations/assessments and previous special education plans (If Applicable) |
|---|---|
| TRANSFER STUDENT APPLICANTS ONLY | Current standardized test scores plus the two previous years’ scores, Current report card including comments and the two previous years’ report cards |
| Mother Names of Parents/Guardians | Julia Whitaker |
| Father Names of Parents/Guardians | Terry Whitaker |
| Mother Signatures | Julia Whitaker |
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: |