Details – Catholic Schools

Applicant Information

Student Name:	Tanvir Nasir	Date	December 8, 2022
Sex	Male	Place of Birth	Lahore,Punjab, Pakistan
Email Address:	raitanvirnasir936@gmail.com	Home Address	Street#3, Muhalla Fareed Nagar, Add Gamber , Distt Sahiwal Lahore, Punjab 54770 United States
Siblings	Sibling 1, Sibling 2, Sibling 3		[]
Name	Sibling 1, Sibling 2, Sibling 3	Grade	7, 9, 8
Religion:	Religion	Baptized:	YES
Local Public School System:	yes	Local Public School Child Would Attend:	Local Public School Child
Race of the Student:	Asian	Ethnicity of Student:	Hispanic

Family Information

	Mother	Father
Full Name	Mother Name	Father Name
Maiden Name	Maiden Name	Maiden Name
Country of Birth	Country of Birth	Country of Birth
Home Address	Home Address	Home Address
Home Phone	000 000 0000	000 000 0000
Mother Cell Phone	000 0000000	000 000 0000
Preferred Email	raitanvirnasir@gmail.com	raitanvirnasir@gmail.com
Mother Occupation	Occupation	Occupation
Employer	Employer	Employer
Mother Work Phone	000 000 0000	000 000 0000
Religion	Religion	Religion
Parish/Church	Parish/Church	Parish/Church

Parents’ Marital Status:	Mother Remarried	Student lives with:	Mother and Father
Full Name	ABC Ba	Country of Birth	Norfolk Island
Home Address	Street#3, Muhalla Fareed Nagar, Add Gamber , Distt Sahiwal	Preferred Email	raitanvirnasir936@gmail.com
Home Phone	000 000 0000	Cell Phone	000 000 0000
Occupation	Company	Employer	Employer
Work Phone	0000000000	Religion	Religion
Parish/Church	Parish/Church	Person responsible for Tuition/Fee Payments:	Person responsible for Tuition/Fee Payments:
Address, City, State, ZIP:	Street#3, Muhalla Fareed Nagar, Add Gamber , Distt Sahiwal	Phone & Email:	raitanvirnasir936@gmail.com

Emergency Contact Information

Contact #1:	Contact #1: Contact #1:	Relation to Student:	Father
Email Address:	raitanvirnasir936@gmail.com	Home Address:	Street#3, Muhalla Fareed Nagar, Add Gamber , Distt Sahiwal ssss Lahore, PU 54770 United States
Home Phone	000 000 0000	Other Phone	000 000 0000
Contact #2	Tanvir Nasir	Relation to Student:	Mother
Email Address	raitanvirnasir936@gmail.com	Home Address:	Street#3, Muhalla Fareed Nagar, Add Gamber , Distt Sahiwal ssss Lahore, pu 54770 United States
Other Phone	0000000000	Home Phone	0000000000

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):	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:	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:	Please list
Does your child have any diagnosed allergies?	NO
If yes, please list (other forms will be required):	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):	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?	YES
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
December 13, 2022	XYZ Svhool	PA	0000000000	90

For Catholic Applicants Only

Current Parish:	Current Parish:	Pastor:	astor:

	Date	Church	City	State
Baptism	December 9, 2022	Church	City	State
Date Reconciliation:	December 9, 2022	Church	City	State
Date First Eucharist	December 21, 2022	Church	City	State
Date Confirmation	December 6, 2022	Church	City	State
Date Other	December 15, 2022	Church	City	State
Date Other	December 20, 2022	Church	City	State

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
Mother Names of Parents/Guardians	Mother name
Father Names of Parents/Guardians	Father Name
Mother Signatures	Signature

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: