Applicant Information
| Student Name: | Watson Elliot | Date | June 7, 2018 |
|---|---|---|---|
| Sex | Male | Place of Birth | Washington,DC, United States |
| Email Address: | andrews_s@live.com | Home Address | 1208 Kennedy Street NW washington, dc 20011 |
| 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 | Shaniece Andrews Watson | Claiborne Watson |
| Maiden Name | Shaniece Andrews | |
| Country of Birth | USA | USA |
| Home Address | 1208 Kennedy Street NW | 8115 Neville Place |
| Home Phone | ||
| Mother Cell Phone | (571) 295 3414 | (240) 210 0111 |
| Preferred Email | andrews_s@live.com | claibornewatson@live.com |
| Mother Occupation | Business Owner | DHS Officer |
| Employer | Self | Navy Yard |
| Mother Work Phone | ||
| Religion | Catholic | Baptist |
| Parish/Church | St Augustine Catholic Church |
| Parents’ Marital Status: | Married | Student lives with: | Mother and Father |
|---|---|---|---|
| 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: | Andrews Juliette | Relation to Student: | Grandmother |
|---|---|---|---|
| Email Address: | herlonda1@hotmail.com | Home Address: | 1208 Kennedy Street NW washington, dc 20011 United States |
| Home Phone | (202) 905 1637 | Other Phone | |
| Contact #2 | Watson Samita | Relation to Student: | Grandmother |
| Email Address | Home Address: | 8115 Neville Place Fort Washington, MD 20744 United States |
|
| Other Phone | Home Phone | (301) 275 1406 |
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 ( Pollen ) |
| 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: | St Augustine Catholic Church | Pastor: |
|---|
| Date | Church | City | State | |
|---|---|---|---|---|
| Baptism | November 4, 2018 | St Augustin Catholic Church | washington | dc |
| 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), All relevant evaluations/assessments and previous special education plans (If Applicable) |
|---|---|
| TRANSFER STUDENT APPLICANTS ONLY | |
| Mother Names of Parents/Guardians | Shaniece E Andrews Watson |
| Father Names of Parents/Guardians | Claiborne M Watson |
| Mother Signatures | Shaniece E Andrews Watson |
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: |