Details – Catholic Schools

Applicant Information

Student Name:	Recinos Kayla	Date	October 20, 2017
Sex	Female	Place of Birth	washington,dc, United States
Email Address:	isisyesenia1208@gmail.com	Home Address	2301 cathedral ave nw #110 washington, dc 20008
Siblings			[]
Name		Grade
Religion:		Baptized:	NO
Local Public School System:	el haynes	Local Public School Child Would Attend:
Race of the Student:	White	Ethnicity of Student:	Hispanic

Family Information

	Mother	Father
Full Name	isis
Maiden Name
Country of Birth	el salvador
Home Address	2301 cathedral ave nw apt 110
Home Phone
Mother Cell Phone	(202) 677 2332
Preferred Email	isisyesenia1208@gmail.com
Mother Occupation	Assistant teacher
Employer	Barbara chambers children center
Mother Work Phone	(202) 387 6755
Religion
Parish/Church

Parents’ Marital Status:	Single	Student lives with:	Mother Only
Full Name		Country of Birth
Home Address		Preferred Email
Home Phone		Cell Phone
Occupation		Employer
Work Phone		Religion
Parish/Church		Person responsible for Tuition/Fee Payments:
Address, City, State, ZIP:		Phone & Email:

Emergency Contact Information

Contact #1:	Arias Maria	Relation to Student:	mother friend
Email Address:		Home Address:
Home Phone		Other Phone	(202) 290 5157
Contact #2	roslaes Aristides	Relation to Student:	mother friend
Email Address		Home Address:
Other Phone	(202) 440 4917	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?	YES
Please list:	patience
Does your child have any diagnosed allergies?
If yes, please list (other forms will be required):
Will your child require medication to be administered during the school day?	YES
If yes, please explain briefly (other forms will be required):	Asthma
Medical Diagnosis: Please check ✓ all that apply:	Diagnosed Condition (specify):
Physical Disability:	No existing physical disability
Learning Disorder:	No known learning disorder

Home Language Survey

Primary language(s) spoken in students household:	English / Spanish
Does primary guardian speak English?	YES
Is the Student Bi-Lingual?	NO
Does the student spend significant time with a non-English speaking caregiver?	YES

Transferring Students

Is the student transferring from another school(s)?

Dates Attended	School Name	City	Phone Number	Grade Avg
August 29, 2022	el Haynes elementary	washington		prek-4

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	isis Recinos
Father Names of Parents/Guardians
Mother Signatures	Isis REcinos

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: