Applicant Information
| Student Name: | Kondeh Mahzi | Date | December 4, 2019 |
|---|---|---|---|
| Sex | Male | Place of Birth | Silver Spring,MD, United States |
| Email Address: | capricia8983@gmail.com | Home Address | 4020 Minnesota Ave NE 564 Washington, DC 20019 United States |
| Siblings | Amelia James | [] | |
| Name | Amelia James | Grade | 4th |
| Religion: | NA | Baptized: | |
| 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 | Abdul Kondeh |
| Maiden Name | ||
| Country of Birth | USA | USA |
| Home Address | 4020 Minnesota ave NE #564 | 4020 Minnesota ave NE #564 |
| Home Phone | (202) 817 0146 | (301) 686 4122 |
| Mother Cell Phone | (202) 817 0146 | (301) 686 4122 |
| Preferred Email | capricia8983@gmail.com | abukondeh1@gmail.com |
| Mother Occupation | technitian | sales |
| Employer | CSOSA | mattress warehouse |
| Mother Work Phone | ||
| Religion | ||
| 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 Washington DC #564 | Preferred Email | |
| Home Phone | Cell Phone | ||
| Occupation | Employer | ||
| Work Phone | Religion | ||
| Parish/Church | Person responsible for Tuition/Fee Payments: |
Parents | |
| Address, City, State, ZIP: | Phone & Email: |
Emergency Contact Information
| Contact #1: | Bryd Margerette | Relation to Student: | Grandmother |
|---|---|---|---|
| Email Address: | Home Address: | 2001 15th st NW DC Washington, DC United States |
|
| Home Phone | (240) 605 3470 | Other Phone | (240) 605 3470 |
| Contact #2 | Calhoun Fanta | Relation to Student: | Aunt |
| Email Address | Home Address: | 9472 Charmed days Laurel, MD United States |
|
| Other Phone | (301) 221 5717 | Home Phone | (301) 221 5717 |
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: | ENG |
|---|---|
| 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)? | 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 | 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 | |
| Mother Names of Parents/Guardians | Capricia Duling |
| Father Names of Parents/Guardians | Abdul Kondeh |
| Mother Signatures | CD |
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: |