Delone Catholic High School Registration Fee AWS

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)  Registration Form

Delone Catholic High School Registration Form (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 White

Student’s Activities and Interests

Student’s Accomplishments

Protestant _____________________________ Hindu Jewish Muslim Other __________________________________

Student’s Parish/ Faith Community

Public School District

Student’s Living Arrangements

Roman Catholic

Other ________________________________________

Current School

Student’s Transportation to School:

Student’s Religion/Faith

     

Zip Code

Name City

 Riding a bus  Riding a car  Carpooling

State

 Driving Self  Walking  Delone Catholic’s Maryland bus service

 Both Parents  Father  Mother  Grandparents  Father/Stepmother  Mother/Stepfather  Guardian

Enrolling in Grade

   

Grade 9 Grade 10 Grade 11 Grade 12

__________________________________________________________________________________________ __________________________________________________________________________________________

__________________________________________________________________________________________ __________________________________________________________________________________________

Family Data Parents’ Marital Status Primary Contact Name Relationship to Student:

 Single

 Married

 Separated

First Name

 Divorced

 Other __________________________________

Middle Initial

Last Name

Phone Number to 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 Relationship to Student:

Primary Contact Employer

Primary Contact Job Title First Name

Middle Initial

Secondary Contact Address  check if same as

Maiden Name

Last Name

Street Address

student

City

State

Zip Code

Please check your preferred phone.

Secondary Contact Phone Numbers

Daytime Phone _________________________________ Evening Phone _________________________________ Cell Phone

Secondary Contact Employer

___________________________________

Secondary Contact Email Address

Secondary Contact Job Title Name Name

Siblings

Name Name Name

Grandparents Information

 Female  Male  Female  Male  Female  Male  Female  Male  Female  Male

Age Age Age Age 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

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

Name

Relationship

Class Year/Attendance Dates

Special Circumstances Has the student skipped a grade?

 Yes  No

If Yes, which grade? ___________

Has the student repeated a grade?

 Yes  No

If Yes, which grade? ___________

Does the student have an IEP or a learning plan?

 Neither

 IEP

 Learning Plan

 Both

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