Applicant Information
| Student Name: | Elisma Danielle | Date | April 29, 2019 |
|---|---|---|---|
| Sex | Female | Place of Birth | Winston Salem,North Carolina, United States |
| Email Address: | boldselismafamily@gmail.com | Home Address | 5155 King Charles Way Bethesda, Maryland 20814 United States |
| Siblings | [] | ||
| Name | Grade | ||
| Religion: | Catholic | Baptized: | YES |
| 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 | Letitia Bolds Elisma | Denmarc Elisma |
| Maiden Name | Bolds | |
| Country of Birth | United States | Maryland |
| Home Address | 5155 King Charles Way | 5155 King Charles Way |
| Home Phone | (336) 312 5738 | (336) 312 5738 |
| Mother Cell Phone | ||
| Preferred Email | boldselismafamily@gmail.com | boldselismafamily@gmail.com |
| Mother Occupation | Health Care | Graduate Student |
| Employer | DOD | Howard University |
| Mother Work Phone | ||
| Religion | AME | Catholic |
| Parish/Church | Kingdom Fellowship | OLOL Bethesda |
| Parents’ Marital Status: | Married | Student lives with: | Mother and Father |
|---|---|---|---|
| Full Name | Letitia Bolds Elisma | Country of Birth | United States |
| Home Address | 5155 King Charles Way | Preferred Email | boldselismafamily@gmail.com |
| Home Phone | (843) 991 6142 | Cell Phone | |
| Occupation | Health Care | Employer | |
| Work Phone | Religion | AME | |
| Parish/Church | Kingdom Fellowship | Person responsible for Tuition/Fee Payments: |
Letitia Bolds Elisma |
| Address, City, State, ZIP: | 5155 King Charles Way | Phone & Email: | (843) 991 6142 |
Emergency Contact Information
| Contact #1: | Bolds Anne Marie | Relation to Student: | Grand-Mother |
|---|---|---|---|
| Email Address: | Home Address: | 12201 King Arrows Bowie, MD 20721 United States |
|
| Home Phone | (240) 505 2223 | Other Phone | |
| Contact #2 | Bolds Malik | Relation to Student: | Uncle |
| Email Address | Home Address: | 12201 Kings Arrow Bowie, Md 20721 |
|
| Other Phone | Home Phone | (301) 543 0897 |
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: | 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: | Creole,French 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 |
|---|---|---|---|---|
| August 21, 2022 | OLOL | Bethesda,MD | LG |
For Catholic Applicants Only
| Current Parish: | OLOL Bthesda | Pastor: | Fr. Rob |
|---|
| Date | Church | City | State | |
|---|---|---|---|---|
| Baptism | August 4, 2019 | Our Lady of Mercy | Winston Salem | North Carolina |
| 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), 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, Current report card including comments and the two previous years’ report cards |
| Mother Names of Parents/Guardians | Letitia Bolds Elisma |
| Father Names of Parents/Guardians | Denmarc Elisma |
| Mother Signatures | Letitia Bolds Elisma |
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: |