Details – Catholic Schools

Applicant Information

Student Name:	Lawrence Abigail	Date	April 2, 2020
Sex	Female	Place of Birth	Washington,DC, United States
Email Address:		Home Address	1863 Newton St NW Washington, DC 20010
Siblings			[]
Name		Grade
Religion:		Baptized:
Local Public School System:		Local Public School Child Would Attend:
Race of the Student:	Black	Ethnicity of Student:

Family Information

	Mother	Father
Full Name	Melanie Lawrence
Maiden Name
Country of Birth	United States
Home Address	1863 Newton St NW
Home Phone
Mother Cell Phone	(202) 340 0261
Preferred Email
Mother Occupation
Employer
Mother Work Phone
Religion
Parish/Church

Parents’ Marital Status:	Single	Student lives with:	Mother Only
Full Name	Melanie Lawrence	Country of Birth	United States
Home Address	1863 Newton St NW	Preferred Email
Home Phone		Cell Phone	(202) 340 0261
Occupation		Employer
Work Phone		Religion
Parish/Church		Person responsible for Tuition/Fee Payments:
Address, City, State, ZIP:		Phone & Email:

Emergency Contact Information

Contact #1:	Kornegay Patricia	Relation to Student:
Email Address:		Home Address:	1863 Newton St NW Washington, DC 20010
Home Phone		Other Phone
Contact #2		Relation to Student:
Email Address		Home Address:
Other Phone		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:
Physical Disability:
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)?	NO

Dates Attended	School Name	City	Phone Number	Grade Avg

For Catholic Applicants Only

Current Parish:		Pastor:

	Date	Church	City	State
Baptism	September 12, 2021	Sacred Heart	Washington	DC
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
Mother Names of Parents/Guardians	Melanie Lawrence
Father Names of Parents/Guardians
Mother Signatures	Melainie Lawrence

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: , :

PERSON RESPONSIBLE FOR TUITION/FEES PAYMENT

Name:		Address:
Phone Number:		NOTES: