Details – Catholic Schools

Applicant Information

Student Name:	Kondeh Mahzi	Date	December 4, 2019
Sex	Female	Place of Birth	Silver,MD, United States
Email Address:	capricia8983@gmail.com	Home Address	4020 Minnesota Ave NE 564 Washington, DC 20019
Siblings	Amelia James		[]
Name	Amelia James	Grade	4th
Religion:	Christian	Baptized:	NO
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	Capricia Duling	Abu Kondeh
Maiden Name
Country of Birth	USA
Home Address	4020 Minnesota Ave NE	4020 Minnesota Ave
Home Phone
Mother Cell Phone	(202) 817 0146	(301) 686 4122
Preferred Email	capricia8983@gmail.com	abukondeh1@gmail.com
Mother Occupation	N/A	Operations supervisor
Employer	N/A	Republics Services
Mother Work Phone
Religion	Christian	Muslim
Parish/Church

Parents’ Marital Status:	Single	Student lives with:	Mother and Father
Full Name	Mahzi Kondeh	Country of Birth	United States
Home Address	4020 Minnesota Ave NE	Preferred Email	Capricia8983@gmail.com
Home Phone		Cell Phone	(202) 817 0146
Occupation		Employer
Work Phone		Religion
Parish/Church		Person responsible for Tuition/Fee Payments:	Mother
Address, City, State, ZIP:		Phone & Email:

Emergency Contact Information

Contact #1:	Byrd Margaret	Relation to Student:	Grandmother
Email Address:		Home Address:	2001 15th St NW Washington, DC 20009 United States
Home Phone		Other Phone	(240) 605 3470
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:	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?
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
Date Reconciliation:
Date First Eucharist
Date Confirmation
Date Other
Date Other

Parent/Guardian Acknowledgment

ALL STUDENT APPLICANTS
TRANSFER STUDENT APPLICANTS ONLY
Mother Names of Parents/Guardians	Capricia Duling
Father Names of Parents/Guardians	Abu Kondeh
Mother Signatures	C. Duling

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: