Delone Catholic High School Registration Fee (Check payable to ...
Delone Catholic High School Student Application for Admission
Need to be returned by U.S. Mail to: Director of Enrollment and Marketing Delone Catholic High School 140 South Oxford Avenue McSherrystown, PA 17344 or by email to: [email protected]
Registration Fee (Check payable to Delone Catholic High School) Student Application for Admission
Delone Catholic High School
Student Application for Admission (Also available at www.DeloneCatholic.org.) School Year Student Data Only Student Name First Name
Middle Initial
Last Name
Street Address
Student Address City
State
Social Security #
Date of Birth
Student’s Email Address
Place of Birth
Student’s Gender
Female Male
Student’s Race/Ethnicity (needed for NCEA Reporting)
American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander
Student’s Religion/Faith
White Other ________________________________________
Zip Code
Roman Catholic Protestant _____________________________ Hindu Jewish Muslim Other __________________________________
Current School Student’s Parish/ Faith Community
Public School District Student’s Transportation to School: Student’s Living Arrangements
Student’s Activities and Interests
Student’s Accomplishments
Name
City
Riding a bus Riding a car Both Parents Mother Father/Stepmother Guardian
State
Driving Self Carpooling Walking Delone Catholic’s Maryland bus service Father Grade 9 Grandparents Grade 10 Enrolling in Grade Mother/Stepfather Grade 11 Grade 12
__________________________________________________________________________________________ __________________________________________________________________________________________
__________________________________________________________________________________________ __________________________________________________________________________________________
Family Data Parents’ Marital Status Primary Contact Name
Single
Married
Separated
First Name
Divorced
Other __________________________________
Middle Initial
Relationship to Student
Last Name
Phone Number for Receive School Alerts
Primary Contact Address check if same as
Street Address
student
City
State
Zip Code
Please check your preferred phone.
Primary Contact Phone Numbers
Daytime Phone ________________________________ Evening Phone ________________________________ Cell Phone __________________________________
Primary Contact Email Address Secondary Contact Name
Primary Contact Employer
Primary Contact Job Title
First Name
Middle Initial
Maiden Name
Last Name
Relationship to Student Secondary Contact Address check if same as
Street Address
student
City
State
Zip Code
Please check your preferred phone.
Secondary Contact Phone Numbers
Daytime Phone _________________________________ Evening Phone _________________________________ Cell Phone ___________________________________
Secondary Contact Email Address
Secondary Contact Employer Secondary Contact Job Title
Name
Siblings (please use an attachment for additional siblings)
Name
Name
Female Male Female Male Female Male
Age
Age
Age
Female Male Name
Grandparents Information
Age
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Relatives Who Are Graduates of Delone Catholic or Attended Delone Catholic (please use an attachment for additional siblings)
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Special Circumstances Has the student skipped a grade?
Yes No
Has the student repeated a grade?
Neither
IEP
Learning Plan
Both
Does the student have an IEP or a learning plan?
Neither
IEP
Learning Plan
Both
If Yes, which grade? ___________
Please sign below if you authorize Delone Catholic High School to request IEP/Learning Plan information from your current school.
__________________________________________________________ If the student does not have an IEP or learning plan, please indicate any learning challenges the student experiences. _____________________________________________________________________________________________________________________________________
If the student does not have an IEP or learning plan, please indicate any physical challenges the student experiences. _____________________________________________________________________________________________________________________________________
Registration Fee Returning Student
New Student A registration fee must accompany this form. Before Dec. 31, pay $75. After Dec. 31, pay $100.
A registration fee must accompany this form. All returning students pay $100.
Cash Check # ______________
Signatures By signing this application form, the parents and/or guardians of the enrolled student hereby agree that they and their student will abide by each of the policies and procedures that may be adopted from time to time by the Diocese of Harrisburg and by Delone Catholic High School, including but not limited to those set forth or referred to in the school’s student/parent handbook.
________________________________________________________________________________________________________________________ Parent/guardian’s Signature
________________________________________________________________________________________________________________________ Parent/guardian’s Signature
_____________ Date
_____________
Please send the Application Form and Payment to: Director of Enrollment and Marketing Delone Catholic High School 140 South Oxford Avenue McSherrystown, PA 17344
Date
Need to be returned by U.S. Mail to: Director of Enrollment and Marketing Delone Catholic High School 140 South Oxford Avenue McSherrystown, PA 17344 or by email to: [email protected]
Registration Fee (Check payable to Delone Catholic High School) Student Application for Admission
Delone Catholic High School
Student Application for Admission (Also available at www.DeloneCatholic.org.) School Year Student Data Only Student Name First Name
Middle Initial
Last Name
Street Address
Student Address City
State
Social Security #
Date of Birth
Student’s Email Address
Place of Birth
Student’s Gender
Female Male
Student’s Race/Ethnicity (needed for NCEA Reporting)
American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander
Student’s Religion/Faith
White Other ________________________________________
Zip Code
Roman Catholic Protestant _____________________________ Hindu Jewish Muslim Other __________________________________
Current School Student’s Parish/ Faith Community
Public School District Student’s Transportation to School: Student’s Living Arrangements
Student’s Activities and Interests
Student’s Accomplishments
Name
City
Riding a bus Riding a car Both Parents Mother Father/Stepmother Guardian
State
Driving Self Carpooling Walking Delone Catholic’s Maryland bus service Father Grade 9 Grandparents Grade 10 Enrolling in Grade Mother/Stepfather Grade 11 Grade 12
__________________________________________________________________________________________ __________________________________________________________________________________________
__________________________________________________________________________________________ __________________________________________________________________________________________
Family Data Parents’ Marital Status Primary Contact Name
Single
Married
Separated
First Name
Divorced
Other __________________________________
Middle Initial
Relationship to Student
Last Name
Phone Number for Receive School Alerts
Primary Contact Address check if same as
Street Address
student
City
State
Zip Code
Please check your preferred phone.
Primary Contact Phone Numbers
Daytime Phone ________________________________ Evening Phone ________________________________ Cell Phone __________________________________
Primary Contact Email Address Secondary Contact Name
Primary Contact Employer
Primary Contact Job Title
First Name
Middle Initial
Maiden Name
Last Name
Relationship to Student Secondary Contact Address check if same as
Street Address
student
City
State
Zip Code
Please check your preferred phone.
Secondary Contact Phone Numbers
Daytime Phone _________________________________ Evening Phone _________________________________ Cell Phone ___________________________________
Secondary Contact Email Address
Secondary Contact Employer Secondary Contact Job Title
Name
Siblings (please use an attachment for additional siblings)
Name
Name
Female Male Female Male Female Male
Age
Age
Age
Female Male Name
Grandparents Information
Age
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Name (Maiden for grandmothers)
Delone Catholic Graduation Year
Address
Email and Phone
Relatives Who Are Graduates of Delone Catholic or Attended Delone Catholic (please use an attachment for additional siblings)
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Name
Relationship
Class Year/Attendance Dates
Special Circumstances Has the student skipped a grade?
Yes No
Has the student repeated a grade?
Neither
IEP
Learning Plan
Both
Does the student have an IEP or a learning plan?
Neither
IEP
Learning Plan
Both
If Yes, which grade? ___________
Please sign below if you authorize Delone Catholic High School to request IEP/Learning Plan information from your current school.
__________________________________________________________ If the student does not have an IEP or learning plan, please indicate any learning challenges the student experiences. _____________________________________________________________________________________________________________________________________
If the student does not have an IEP or learning plan, please indicate any physical challenges the student experiences. _____________________________________________________________________________________________________________________________________
Registration Fee Returning Student
New Student A registration fee must accompany this form. Before Dec. 31, pay $75. After Dec. 31, pay $100.
A registration fee must accompany this form. All returning students pay $100.
Cash Check # ______________
Signatures By signing this application form, the parents and/or guardians of the enrolled student hereby agree that they and their student will abide by each of the policies and procedures that may be adopted from time to time by the Diocese of Harrisburg and by Delone Catholic High School, including but not limited to those set forth or referred to in the school’s student/parent handbook.
________________________________________________________________________________________________________________________ Parent/guardian’s Signature
________________________________________________________________________________________________________________________ Parent/guardian’s Signature
_____________ Date
_____________
Please send the Application Form and Payment to: Director of Enrollment and Marketing Delone Catholic High School 140 South Oxford Avenue McSherrystown, PA 17344
Date
