Applicant Information
| Student Name: | Weston Lelah | Date | April 1, 2011 |
|---|---|---|---|
| Sex | Female | Place of Birth | Oakland,California, United States |
| Email Address: | aminahfoster.af@gmail.com | Home Address | 11807 Fairgreen Ln Upper Marlboro, Maryland 20772 United States |
| Siblings | [] | ||
| Name | Grade | ||
| Religion: | Baptist | Baptized: | YES |
| Local Public School System: | Local Public School Child Would Attend: | ||
| Race of the Student: | Black | Ethnicity of Student: | Non-Hispanic |
Family Information
| Mother | Father | |
|---|---|---|
| Full Name | Lateefah Simon | Kevin Weston |
| Maiden Name | Simon | |
| Country of Birth | United States | United States |
| Home Address | 6251 Shellmound St, Apt 1115 | |
| Home Phone | ||
| Mother Cell Phone | (415) 420 7415 | |
| Preferred Email | lateefah77@gmail.com | |
| Mother Occupation | CEO, incoming Congressmember | |
| Employer | Meadow Foundation | |
| Mother Work Phone | ||
| Religion | Baptist | |
| Parish/Church |
| Parents’ Marital Status: | Single, Father Deceased | Student lives with: | Mother Only |
|---|---|---|---|
| Full Name | Lateefah Simon | Country of Birth | United States |
| Home Address | 6251 Shellmound St, Apt 1115 | Preferred Email | lateefah77@gmail.com |
| Home Phone | Cell Phone | (415) 420 7415 | |
| Occupation | CEO, incoming Congressmember | Employer | Meadow Foundation |
| Work Phone | Religion | Baptist | |
| Parish/Church | Person responsible for Tuition/Fee Payments: |
Lateefah Simon | |
| Address, City, State, ZIP: | 6251 Shellmound St, Apt 1115 | Phone & Email: | (415) 420 7415 |
Emergency Contact Information
| Contact #1: | Foster Aminah | Relation to Student: | Adult Sister |
|---|---|---|---|
| Email Address: | aminahfoster.af@gmail.com | Home Address: | 11807 Fairgreen Ln Upper Marlboro, MD 20772 United States |
| Home Phone | Other Phone | ||
| Contact #2 | Foster Kenny | Relation to Student: | Brother in law |
| Email Address | kentfostersf@gmail.com | Home Address: | 11807 Fairgreen Ln Upper Marlboro, MD 20772 United States |
| 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? | YES |
| If yes, please list (other forms will be required): |
Seasonal allergies (most species of grass and pollen). No food allergies/intolerances. |
| Will your child require medication to be administered during the school day? | YES |
| 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 |
|---|---|---|---|---|
| August 15, 2022 | St. John the Baptist School | El Cerrito | (510) 234-2244 | 80 |
For Catholic Applicants Only
| Current Parish: | St. John the Baptist | 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 | Lateefah Simon |
| Father Names of Parents/Guardians | |
| Mother Signatures | Lateefah Simon |
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: |