DIOCESE OF COLUMBUS - REGISTRATION FORM The schools of the Diocese of Columbus recruit and admit students of any race, color, or ethnic origin to all its rights, privileges, programs, and activities. In addition, the school will not discriminate on the basis of race, color, or ethnic origin in the administration of its educational programs and athletics/extracurricular activities. Furthermore, the school is not intended to be an alternative to court or administrative agency ordered, or public school district initiated desegregation.
Race (You are not required to provide this information.) Asian American Indian/Native Alaskan
Black Hispanic
Multiracial Native Hawaiian/Pacific Islander
White Under 12 years / High School Grad / College Non-Grad / College Grad / Beyond College
FAMILY Last Name
First Name
Work Phone
Cell Phone
Birthplace
Religion
Education
Father Mother Guardian Home Phone
Email
Father Mother Guardian Type of Occupation
Place of Occupation
Father Mother Guardian
HOME STATUS OF PARENT(S) Married
Separated
Divorced
Check all that apply. Single Mother Deceased
Father Deceased
Student lives with: (CHECK ALL THAT APPLY.) Mother/Custodial Stepmother Stepfather Guardian/Custodial
Both Parents Father/Custodial
Shared Parenting
If separated or divorced, a copy of custody papers has been provided. Language spoken in home English
Spanish
Other
SACRAMENTS Date
Church
City
State
Baptism Eucharist Confirmation
ENTRANCE AND WITHDRAWAL Date Entered
Prior School
Prior School City/State/Zip
Grade Entered
PUBLIC SCHOOL DISTRICT INFORMATION Public School District
Public Elem. School in Attend. Area
Public Middle School in Attend. Area
The design of the Registration Card is the property of the Diocese of Columbus and may not be altered.
Revised 2008
Student Information Form (Please complete a form for each new student registering for St. Matthew School.)
Student Name ____________________________________________________ Age/Birthdate ____________________________________________________ Grade Entering ___________________________________________________ Please answer the following questions: 1. Has your child received any academic tutoring support?
Yes
No
If yes, please list subjects where support was needed. ___________________________________________________________ If yes, please list all grade levels where support was provided. ___________________________________________________________ 2. Has your child ever been referred to an intervention team?
Yes
No
3. Has your child needed behavioral support?
Yes
No
4. Has your child ever had a formal academic evaluation?
Yes
No
5. Does your child have an Individualized Education Plan (IEP) or Service Plan? Yes
No
6. Does your child have a 504 or an Academic Support Plan?
Yes
No
7. Has your child repeated a grade?
Yes
No
If you answered YES to questions 4, 5 or 6, please provide the school copies of the documents. St. Matthew School has made great strides in providing support for our special needs students. Although funding from the Jon Peterson Special Needs Scholarship has provided additional intervention services, we remain limited in the level of support offered. We will use the documentation and information provided above to start the conversation about your child's individual needs. Together, we will determine whether St. Matthew has the appropriate resources available to allow for his or her success.
Work Phone Cell Phone. Type of Occupation Place of Occupation. Mother. Guardian. Home Phone Email. Father. Mother. Guardian. Public School District Public ...
All typically. developing children must be fully toilet trained. Bussing service is NOT available. Location Information: Lake Middle School. 28100 Lemoyne Rd.
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Cell Phone (_____)_____-______ ... information and may disclose such information to the above-named Insurance Company(ies) and ... consent will end when my current treatment plan is completed or one year from the date signed below.
(Name of State/Country). MATC appreciates your cooperation in completing the following information, which is needed to meet State and Federal reporting.
Registration Form â International Conference - Adwitya 2016. 1. Registration Details. Please note: If more than one person from an organisation or institution ...
Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc.
Date. Time Slot. Available (Y / N). A. Saturday June 23rd. 8:00A to 12 N. B. Saturday June 23rd. 12 N to 4 PM. C. Saturday June 23rd. 4 PM to 8 PM. D. Saturday ...
NOTE : ALL INFORMATION SHOULD BE FILL IN ENGLISH CAPITAL LETTERS ONLY. 1 NAME OF SECRETARIAT. : 2 NAME OF DEPARTMENT. : 3 NAME OF INSTITUTE / OFFICE. : 4 OFFICE ADDRESS. : PHONE NUMBER. 5 NAME AND DESIGNATION OF HEAD OF. INSTITUTE/OFFICE. CONTACT NUM
born in any State (any of the 50 states, the Commonwealth of Puerto Rico, the district of Columbia, Guam, American Samoa, the. Virgin Islands, the Northern ...
I understand that bicycles, skateboards, baby joggers, roller skates or roller blades, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these facts and inconsidera
Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc.
Post/zip code: Country: This is the address that your certificate will be sent to. If you want your centre to send it to a different address,. please contact the centre directly. Passport or national ID number: (this must be the ID you will bring wit
