Application Kinder
Dear Prospective St. Dominic School Kindergarten Family, Thank you for your interest in St. Dominic Catholic School. After reviewing the attached information carefully, please complete and return this application with the required documentation and the application fee as soon as possible. Once all materials have been submitted to our office, your child will be added to the schedule for testing, which begins February 17, 2015. Testing sessions may last from 15-25 minutes, and are designed to determine the developmental readiness of your child for Kindergarten. Following California State Law, to enter Kindergarten, a child must turn 5 years old on or before September 1, 2014. During the testing time, I will be available to answer questions you may have about the expectations for parents/students at our school. St. Dominic School in the Diocese of Sacramento, does not discriminate on the basis of race, color, nationality and/or ethnicity, age, gender, or disability in the administration of education policies, admission policies, scholarship and loan programs, and athletic and or other schooladministered programs. In addition to testing, students are considered for acceptance at St. Dominic School based on the following priorities: 1. Registered and active members of St. Dominic Parish with children already enrolled in the school, including St. Dominic Preschool. 2. Registered and active members of St. Dominic Parish. 3. Siblings of non-Parish families already enrolled in St. Dominic School. 4. Non-Parish Catholics enrolled in St. Dominic Preschool. 5. Non-Catholic families will be accepted if the school has the capacity for additional students. A student shall be admitted if he/she has a reasonable, well-founded hope of successfully completing the academic program at St. Dominic School. Students will be admitted on a probationary basis, for the duration of one trimester (12 weeks), at which time an assessment will be made as to their academic and behavioral progress. These priorities are guidelines only. The Pastor and Principal have broad discretionary authority over the application of these guidelines to specific situations. We look forward to the opportunity to support you in providing a quality Catholic education for your child. Sincerely, Katie Perata Principal
(revised 1/14)
ST. DOMINIC SCHOOL APPLICATION FOR ADMISSION SCHOOL YEAR 2015-2016
Applying for Grade
Date of Application___________________
Name of Student ________________________________________
M____ F_____
Date of Birth_______________________ Place of Birth__________________________ Applicant’s Religious Affiliation _____________________________________________ Baptism Date ___________________
Church_____________________________
1st Communion Date______________
Church_____________________________
Presently enrolled at _______________________________________________________ Grade
Phone number __________________Address___________________________________ FATHER
MOTHER (Maiden Name)
Name__________________________
Name
Address________________________
Address_____________________________
_____
Street
Street
____________________________ City
Zip
__________________________________ City
Zip
Home Phone____________________
Home Phone _________________________
Cell Phone _____________________
Cell hone ___________________________
E-Mail ________________________
E-Mail _____________________________
Occupation ____________________ _
Occupation __________________________
Employer ______________________ ______________________
Employer ___________________________ ___________________________
Religious Affiliation ____________
Religious Affiliation __________________
(Revised 1/11)
Has applicant ever repeated a grade? Comments:
Yes___ No___
Has applicant had learning problems identified? Yes___ No___ of the learning problem?
Which grade?____
What was the nature
Applicant lives with: ____ Both Parents ____ Mother ____ Father ____ Guardian List other children currently attending St. Dominic’s: ____________________________ List other children applying to St. Dominic’s: ___________________________________ Are you a registered and contributing member of St. Dominic Parish? _____________ Envelope Registration Number ________________ Are you a registered member of another Parish? _______ Name of Parish____________ Please attach a copy of:
Birth Certificate
Shot Records
Baptismal Certificate
For Grades 1-8, please attach a copy of latest report card and standardized test results. Give Confidential Teacher Report and Release & Consent form to current teacher with a pre-addressed envelope for its return to St. Dominic School. Thank you for your application to St. Dominic School. New applicants should attach a $35.00 non-refundable application fee per application. Once your application and testing have been completed, your child will be placed on our waiting list. You will be notified when a space for your child is available. Applications must be renewed every year. Signature of Parent__________________________________Date_________________ A limited amount of financial aid is available for families with a demonstrated need for assistance. Please check if you wish to apply. _____ (Revised 1/11)
Family Name (please print)___________________________________________________ Please answer the following questions to the best of your ability: 1. Why are you choosing St. Dominic Catholic School? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________
2. If you are transferring from another elementary school, why are you making the change? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________________________
3. If your child is admitted to St. Dominic, what skills or talents can you bring to our school community as a family? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________________________
How did you hear about our school? (Check all that apply!) ____ Family
____ Friend/Co-worker whose child attends (Name ________________)
____ Church
____ Preschool
____ Sign in front of school
____ Catholic Herald
____ SDS Website
____ Catholic School Dept. Website
____ Other (Please indicate) ______________________________________________________ (Revised 1/11)
Release and Consent Form Parents, please give a copy of this consent form and the attached Teacher Report to your child’s current classroom teacher. Applications will not be considered complete until we have received this form. Your signature on this form indicates that your child’s current classroom teacher has your permission to release his/her confidential evaluation of your child to St. Dominic School. Current Teacher, please complete and return the attached Teacher Report to: St. Dominic School 935 East 5th Street Benicia, CA 94510 We respectfully ask that you complete and return this form as quickly as possible in order to best facilitate the application process. The information on this form is confidential between you and the Administration of St. Dominic School.
Student’s Name______________________________________________ (please print) Parent/Guardian Signature____________________________________________________ Date _______________________________________________________
(Revised 1/13)
St. Dominic
Catholic School Confidential Teacher Report
Student Name ______________________________ Current Grade_____
Student Name ______________________________ Current Grade_____ Class Level: Accelerated Fair Average Low Academic Evaluation: Please check appropriate ratings for the following: limited
Academic potential
fair
average
good
outstanding
considerably below expectations somewhat below par as expected better than tests far above
Academic achievement expectations
does very little only that required sets high goals
Self-motivation
limited
Effort, drive
occasional
poor
Study habits
fair
excellent
has great difficulty usually effective
Ability to work in a group
Participation in discussion
rarely contributes
sometimes unable to cope always works well
wants to dominate contributes when called upon contributes occasionally joins in readily rarely if prodded
Reads for pleasure
occasionally
uses poorly usually uses well
Organization of work poor
frequently
fair
occasionally wastes always uses effectively
average
good
excellent
needs much explanation
occasionally needs help quickly and correctly
Uses suggestions or corrections Critical and abstract thinking Seeks help when needed
limited has some difficulty average exceptionally good
Ability to express ideas orally
Follows directions
good
maximum
needs much supervision needs help frequently needs help occasionally always works well
Ability to work alone
Use of time
usually good
rarely heeds weak
needs reminding
occasional insight
rarely occasionally
usually
frequently good
always exceptional
usually always (Revised
1/13)
Attention span
easily distracted usually good
Maturity in terms of age & grade very immature above average
occasionally distracted exceptionally good somewhat mature very mature
normal
above average I
very mature
cannot be trusted questionable usually trustworthy highly developed
Integrity and honesty
thoughtless usually considerate
Consideration of others
seldom considerate always considerate
has serious problems
Social adjustment with peers
has frequent minor problems
has occasional minor problems very healthy a follower leads when put in position seeks opportunities and uses them well a natural leader
Leadership potential
troublemaker
Classroom conduct
usually good Emotional stability
insecure
Personality
withdrawn pleasing
occasionally disrupts always good
overly tense
stable
overly aggressive unusually interesting
rarely laughs or smiles
Sense of humor
attention getter
normal
good
delightful
needs much reassurance appears overly confident needs some support healthy self-image
Self confidence
rarely
Cooperates with adults Cooperation of parents
poor
fair
sometimes good
usually
always
outstanding
Please check words which best describe this student vivacious good-humored friendly well-liked aloof sociable belligerent forthright aggressive sullen shy stubborn persistent cheerful self-centered poised nervous irritable easily discouraged influential (wholesomely, unwholesomely) passive
Other Comments :
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Teacher’s Signature_______________________________________________ Date________________________ Subject Taught_________________________________ School_________________________________________
(revised 1/14)
ST. DOMINIC SCHOOL APPLICATION FOR ADMISSION SCHOOL YEAR 2015-2016
Applying for Grade
Date of Application___________________
Name of Student ________________________________________
M____ F_____
Date of Birth_______________________ Place of Birth__________________________ Applicant’s Religious Affiliation _____________________________________________ Baptism Date ___________________
Church_____________________________
1st Communion Date______________
Church_____________________________
Presently enrolled at _______________________________________________________ Grade
Phone number __________________Address___________________________________ FATHER
MOTHER (Maiden Name)
Name__________________________
Name
Address________________________
Address_____________________________
_____
Street
Street
____________________________ City
Zip
__________________________________ City
Zip
Home Phone____________________
Home Phone _________________________
Cell Phone _____________________
Cell hone ___________________________
E-Mail ________________________
E-Mail _____________________________
Occupation ____________________ _
Occupation __________________________
Employer ______________________ ______________________
Employer ___________________________ ___________________________
Religious Affiliation ____________
Religious Affiliation __________________
(Revised 1/11)
Has applicant ever repeated a grade? Comments:
Yes___ No___
Has applicant had learning problems identified? Yes___ No___ of the learning problem?
Which grade?____
What was the nature
Applicant lives with: ____ Both Parents ____ Mother ____ Father ____ Guardian List other children currently attending St. Dominic’s: ____________________________ List other children applying to St. Dominic’s: ___________________________________ Are you a registered and contributing member of St. Dominic Parish? _____________ Envelope Registration Number ________________ Are you a registered member of another Parish? _______ Name of Parish____________ Please attach a copy of:
Birth Certificate
Shot Records
Baptismal Certificate
For Grades 1-8, please attach a copy of latest report card and standardized test results. Give Confidential Teacher Report and Release & Consent form to current teacher with a pre-addressed envelope for its return to St. Dominic School. Thank you for your application to St. Dominic School. New applicants should attach a $35.00 non-refundable application fee per application. Once your application and testing have been completed, your child will be placed on our waiting list. You will be notified when a space for your child is available. Applications must be renewed every year. Signature of Parent__________________________________Date_________________ A limited amount of financial aid is available for families with a demonstrated need for assistance. Please check if you wish to apply. _____ (Revised 1/11)
Family Name (please print)___________________________________________________ Please answer the following questions to the best of your ability: 1. Why are you choosing St. Dominic Catholic School? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________
2. If you are transferring from another elementary school, why are you making the change? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________________________
3. If your child is admitted to St. Dominic, what skills or talents can you bring to our school community as a family? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________________________
How did you hear about our school? (Check all that apply!) ____ Family
____ Friend/Co-worker whose child attends (Name ________________)
____ Church
____ Preschool
____ Sign in front of school
____ Catholic Herald
____ SDS Website
____ Catholic School Dept. Website
____ Other (Please indicate) ______________________________________________________ (Revised 1/11)
Release and Consent Form Parents, please give a copy of this consent form and the attached Teacher Report to your child’s current classroom teacher. Applications will not be considered complete until we have received this form. Your signature on this form indicates that your child’s current classroom teacher has your permission to release his/her confidential evaluation of your child to St. Dominic School. Current Teacher, please complete and return the attached Teacher Report to: St. Dominic School 935 East 5th Street Benicia, CA 94510 We respectfully ask that you complete and return this form as quickly as possible in order to best facilitate the application process. The information on this form is confidential between you and the Administration of St. Dominic School.
Student’s Name______________________________________________ (please print) Parent/Guardian Signature____________________________________________________ Date _______________________________________________________
(Revised 1/13)
St. Dominic
Catholic School Confidential Teacher Report
Student Name ______________________________ Current Grade_____
Student Name ______________________________ Current Grade_____ Class Level: Accelerated Fair Average Low Academic Evaluation: Please check appropriate ratings for the following: limited
Academic potential
fair
average
good
outstanding
considerably below expectations somewhat below par as expected better than tests far above
Academic achievement expectations
does very little only that required sets high goals
Self-motivation
limited
Effort, drive
occasional
poor
Study habits
fair
excellent
has great difficulty usually effective
Ability to work in a group
Participation in discussion
rarely contributes
sometimes unable to cope always works well
wants to dominate contributes when called upon contributes occasionally joins in readily rarely if prodded
Reads for pleasure
occasionally
uses poorly usually uses well
Organization of work poor
frequently
fair
occasionally wastes always uses effectively
average
good
excellent
needs much explanation
occasionally needs help quickly and correctly
Uses suggestions or corrections Critical and abstract thinking Seeks help when needed
limited has some difficulty average exceptionally good
Ability to express ideas orally
Follows directions
good
maximum
needs much supervision needs help frequently needs help occasionally always works well
Ability to work alone
Use of time
usually good
rarely heeds weak
needs reminding
occasional insight
rarely occasionally
usually
frequently good
always exceptional
usually always (Revised
1/13)
Attention span
easily distracted usually good
Maturity in terms of age & grade very immature above average
occasionally distracted exceptionally good somewhat mature very mature
normal
above average I
very mature
cannot be trusted questionable usually trustworthy highly developed
Integrity and honesty
thoughtless usually considerate
Consideration of others
seldom considerate always considerate
has serious problems
Social adjustment with peers
has frequent minor problems
has occasional minor problems very healthy a follower leads when put in position seeks opportunities and uses them well a natural leader
Leadership potential
troublemaker
Classroom conduct
usually good Emotional stability
insecure
Personality
withdrawn pleasing
occasionally disrupts always good
overly tense
stable
overly aggressive unusually interesting
rarely laughs or smiles
Sense of humor
attention getter
normal
good
delightful
needs much reassurance appears overly confident needs some support healthy self-image
Self confidence
rarely
Cooperates with adults Cooperation of parents
poor
fair
sometimes good
usually
always
outstanding
Please check words which best describe this student vivacious good-humored friendly well-liked aloof sociable belligerent forthright aggressive sullen shy stubborn persistent cheerful self-centered poised nervous irritable easily discouraged influential (wholesomely, unwholesomely) passive
Other Comments :
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Teacher’s Signature_______________________________________________ Date________________________ Subject Taught_________________________________ School_________________________________________
