Applicant Information
| Student Name: | BINYAM NAOMI | Date | July 23, 2016 |
|---|---|---|---|
| Sex | Female | Place of Birth | washington,District of Columbia, United States |
| Email Address: | binyam86@gmail.com | Home Address | 1301 14TH ST NW APT 800 washington, District of Columbia 20001 United States |
| Siblings | [] | ||
| Name | Grade | ||
| Religion: | ORTHODOX | Baptized: | |
| Local Public School System: | SEATON ELEMENTARY SCHOOL | Local Public School Child Would Attend: | SEATON ELEMENTARY SCHOOL |
| Race of the Student: | Black | Ethnicity of Student: | Non-Hispanic |
Family Information
| Mother | Father | |
|---|---|---|
| Full Name | Rahel | WRGESSA |
| Maiden Name | ||
| Country of Birth | ETHIOPIA | |
| Home Address | 1301 14TH ST NW, WASHINGTON DC | |
| Home Phone | ||
| Mother Cell Phone | (301) 804 7069 | |
| Preferred Email | rahelaberaw@gmail.com | |
| Mother Occupation | DATA CENTER TECHNICAL | |
| Employer | TEKSYSTEM | |
| Mother Work Phone | ||
| Religion | ORTHODOX | |
| Parish/Church |
| Parents’ Marital Status: | Married | Student lives with: | Mother and Father |
|---|---|---|---|
| Full Name | BINYA ASFAW | Country of Birth | Ethiopia |
| Home Address | 1301 14TH ST NW APT 800 WASHINGTON DC 20005 | Preferred Email | BINYAM86@GMAIL.COM |
| Home Phone | Cell Phone | (571) 275 7021 | |
| Occupation | TRAVEL CONSULTANT | Employer | BITNA TRAVEL |
| Work Phone | Religion | ORTHODOX | |
| Parish/Church | Person responsible for Tuition/Fee Payments: |
BINYAM ASFAW | |
| Address, City, State, ZIP: | 1301 14TH ST NW APT 800, WASHINGTON, DC 20005 | Phone & Email: | (571) 275 7021 |
Emergency Contact Information
| Contact #1: | ASFAW BINYAM | Relation to Student: | FATHER |
|---|---|---|---|
| Email Address: | BINYAM86@GMAIL.COM | Home Address: | 1301 14TH ST NW APT 800 washington, DC 20005 United States |
| Home Phone | (571) 275 7021 | Other Phone | |
| Contact #2 | WRGESSA RAHEL | Relation to Student: | MOTHER |
| Email Address | rahelaberaw@gmail.com | Home Address: | 1301 14TH ST NW APT 800 washington, District of Columbia 20005 United States |
| Other Phone | (301) 804 7069 | 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)? | 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: | AMHARIC |
|---|---|
| Does primary guardian speak English? | NO |
| Is the Student Bi-Lingual? | YES |
| Does the student spend significant time with a non-English speaking caregiver? | NO |
Transferring Students
| Is the student transferring from another school(s)? | NO |
|---|
| Dates Attended | School Name | City | Phone Number | Grade Avg |
|---|---|---|---|---|
| March 28, 2024 | seaton elementary school | washington | 2nd grade |
For Catholic Applicants Only
| Current Parish: | Pastor: |
|---|
| Date | Church | City | State | |
|---|---|---|---|---|
| Baptism | ||||
| 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) |
|---|---|
| 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 | RAHEL WRGESSA |
| Father Names of Parents/Guardians | BINYAM ASFAW |
| Mother Signatures | RAHEL WRGESSA |
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: |