Applicant Information
| Student Name: | Yael Apolonio | Date | December 27, 1985 |
|---|---|---|---|
| Sex | Female | Place of Birth | Washington,DC, United States |
| Email Address: | yaminahgilles@gmail.com | Home Address | 1700 Euclid Street NW, A2 Washington, DC 20009 United States |
| Siblings | N/A | [] | |
| Name | N/A | Grade | |
| Religion: | Christian | Baptized: | NO |
| Local Public School System: | Local Public School Child Would Attend: | Hyde-Addison ES | |
| Race of the Student: | Two or more races | Ethnicity of Student: | Non-Hispanic |
Family Information
| Mother | Father | |
|---|---|---|
| Full Name | Yaminah | Leonardo |
| Maiden Name | Gilles | Apolonio |
| Country of Birth | USA | USA |
| Home Address | 1700 Euclid Street NW, Unit A2 | 930 M St NW, Apt 610 |
| Home Phone | ||
| Mother Cell Phone | (202) 556 5649 | (410) 294 7590 |
| Preferred Email | yaminahgilles@gmail.com | |
| Mother Occupation | Teacher | Data Scientist |
| Employer | Howard University | Qualtrics |
| Mother Work Phone | ||
| Religion | Christian | |
| Parish/Church | St. Augustine |
| Parents’ Marital Status: | Separated* | Student lives with: | Part-time with Father/Mother |
|---|---|---|---|
| Full Name | Yaminah Gilles | Country of Birth | United States |
| Home Address | 1700 Euclid Street NW, A2 | Preferred Email | yaminahgilles@gmail.com |
| Home Phone | Cell Phone | (202) 556 5649 | |
| Occupation | Teacher | Employer | Howard University |
| Work Phone | Religion | Christian | |
| Parish/Church | St. Augustine | Person responsible for Tuition/Fee Payments: |
Yaminah Gilles |
| Address, City, State, ZIP: | 1700 Euclid Street NW, Unit A2 | Phone & Email: | (202) 556 5649 |
Emergency Contact Information
| Contact #1: | Gilles Agathe | Relation to Student: | Grandmother |
|---|---|---|---|
| Email Address: | agglls@aol.com | Home Address: | 4344 Argyle Terrace NW Washington, DC 20011 United States |
| Home Phone | Other Phone | (202) 766 2682 | |
| Contact #2 | Cornelius Melissa | Relation to Student: | Aunt |
| Email Address | melissacornelius08@gmail.com | Home Address: | 836 Varnum Street NW, Unit 101 Washington, DC 20011 United States |
| Other Phone | (202) 277 0586 | 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 |
| Will your child require medication to be administered during the school day? | YES |
| If yes, please explain briefly (other forms will be required): |
Rescue asthma medications as needed. |
| 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, Haitian Creole |
|---|---|
| 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)? | YES |
|---|
| Dates Attended | School Name | City | Phone Number | Grade Avg |
|---|---|---|---|---|
| August 2, 2021 | Ideal Child Care Development Center | Washington, DC | 202 722-0633 | N/A |
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 | Yaminah Gilles |
| Father Names of Parents/Guardians | |
| Mother Signatures | Yaminah Gilles |
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: |