Applicant Information
| Student Name: | Moore Taylor-Elizabeth | Date | February 24, 2011 |
|---|---|---|---|
| Sex | Female | Place of Birth | washington,District of Columbia, United States |
| Email Address: | taytay_moore@icloud.com | Home Address | 2480 16th St NW Apt 717 DISTRICT OF COLUMBIA, DC 20009 United States |
| Siblings | Taylor-Elizabeth Moore | [] | |
| Name | Taylor-Elizabeth Moore | Grade | 8th |
| Religion: | catholic | Baptized: | NO |
| Local Public School System: | DCPS | Local Public School Child Would Attend: | Columbia Heights Educational Campus |
| Race of the Student: | Black | Ethnicity of Student: |
Family Information
| Mother | Father | |
|---|---|---|
| Full Name | Tia Maria Watson | Jermanine Moore |
| Maiden Name | Watson | |
| Country of Birth | United States | United States |
| Home Address | 2480 16th St NW | Apt 717 |
| Home Phone | (202) 425 4450 | |
| Mother Cell Phone | (202) 309 0423 | |
| Preferred Email | tia_watson@hotmail.com | tia_watson@hotmail.com |
| Mother Occupation | Home Economist | |
| Employer | ||
| Mother Work Phone | ||
| Religion | Catholic | |
| Parish/Church | St. Augustine |
| Parents’ Marital Status: | Single | Student lives with: | Mother Only |
|---|---|---|---|
| Full Name | Tia Maria Watson | Country of Birth | United States |
| Home Address | 2480 16th St NW | Preferred Email | tia_watson@hotmail.com |
| Home Phone | (202) 309 0423 | Cell Phone | (202) 309 0423 |
| Occupation | Home Econmist | Employer | |
| Work Phone | Religion | ||
| Parish/Church | Person responsible for Tuition/Fee Payments: |
Serving Our Children | |
| Address, City, State, ZIP: | 1707 L St NW Ste 300, Washington, DC 20036 | Phone & Email: | (202) 464 6712 |
Emergency Contact Information
| Contact #1: | Jackson-Morgan Lori | Relation to Student: | cousin |
|---|---|---|---|
| Email Address: | lpmorgan70@gmail.com | Home Address: | |
| Home Phone | Other Phone | (540) 846 5522 | |
| Contact #2 | Gwynn Rachelle | Relation to Student: | Aunt |
| Email Address | ray_gwynn@yahoo.com | Home Address: | |
| Other Phone | (704) 293 0342 | 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: | |
| Learning Disorder: |
Home Language Survey
| Primary language(s) spoken in students household: | English |
|---|---|
| Does primary guardian speak English? | YES |
| Is the Student Bi-Lingual? | |
| 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 |
|---|---|---|---|---|
| August 25, 2023 | Columbia Heights Educational Campus | Washington, DC | 2029397700 | 3.0 |
For Catholic Applicants Only
| Current Parish: | St.Augustine | Pastor: | Father Kelly |
|---|
| 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 |
|---|---|
| TRANSFER STUDENT APPLICANTS ONLY | |
| Mother Names of Parents/Guardians | Tia Watson |
| Father Names of Parents/Guardians | Jermaine Moore |
| Mother Signatures | Tia Watson |
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: |