Monsignor Donovan Catholic High School
590 Lavender Road, Athens, Georgia 30606-1114
Tel: 706-433-0223 Fax: 706-433-0229 www.mdchs.org
2016-2017
APPLICATION
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Applicant Name
Picture
ofApplicant
Monsignor Donovan Catholic High School
2016-2017 Academic School Year
Please fill in all of the information requested completely and legibly.
Applicant Information
Name of Applicant: ______
Last First Middle
Does this applicant have any other last name, which might appear on school records? ____Yes ____No
If yes, please indicate name: ______Applicant’s Social Security Number: ______
Home Address: ______City: ______
State:______Zip Code:______County:______Home Phone:______
Student Cell Phone: ______Student E-mail address: ______
Parent E-mail address: ______Applicant’s Date of Birth: ______/______/______
Month Day Year
Applying to Grade: ______Country of citizenship: Mother ______Father ______Applicant ______
If a language other than, or in addition to, English is spoken at home, please indicate: ______
For statistical purposes, how should the applicant be identified (optional):
□ Asian American □ American Indian □ African American □ Hispanic American □ Caucasian □ Other
Religious Affiliation: ______Church: ______
Religious Information of Applicant (if Catholic):
Baptism ______/______First Communion ______/______
Date Parish Date Parish
First Reconciliation ______/______Confirmation______/______
Date Parish Date Parish
Parent/Guardian Information
Mother/Guardian: Mother’s Name: □ Dr. □ Mrs. □ Ms. □ Other ______
Home Address: (if different than applicant’s) ______
Telephone: ______Cell: ______Business Telephone: ______
Occupation: ______Company: ______Business E-mail: ______
Father/Guardian: Father’s Name: □ Dr. □ Mr. □ Other ______
Home Address: (if different than applicant’s) ______
Telephone: ______Cell: ______Business Telephone: ______
Occupation: ______Company: ______Business E-mail: ______
Parents are: □ residing together □ divorced □ separated □ deceased
Applicant resides with: (Check all that apply) □ mother □ father □ stepfather □ stepmother □ grandparents □ guardian
Send all correspondence to: □ Home Address of Applicant □ Father’s Business Address □ Mother’s Business Address
Who has legal custody of the applicant? □ Both Parents □ Mother □ Father □ Other: specify ______
Financial obligations will be assumed by: □ parent’s □ father □ mother □ guardian
Grandparent Information
Maternal Grandfather: Grandfather’s Name: □ Dr. □ Mrs. □ Ms. □ Other ______
Home Address: ______
Telephone: ______Cell: ______Business Telephone: ______
Occupation/Occupation before Retirement: ______Company: ______
E-mail: ______Business E-mail: ______
Maternal Grandmother: Grandmother’s Name: □ Dr. □ Mrs. □ Ms. □ Other ______
Home Address: ______
Telephone: ______Cell: ______Business Telephone: ______
Occupation/Occupation before Retirement: ______Company: ______
E-mail: ______Business E-mail: ______
Paternal Grandfather: Grandfather’s Name: □ Dr. □ Mrs. □ Ms. □ Other ______
Home Address: ______
Telephone: ______Cell: ______Business Telephone: ______
Occupation/Occupation before Retirement: ______Company: ______
E-mail: ______Business E-mail: ______
Paternal Grandmother: Grandmother’s Name: □ Dr. □ Mrs. □ Ms. □ Other ______
Home Address: ______
Telephone: ______Cell: ______Business Telephone: ______
Occupation/Occupation before Retirement: ______Company: ______
E-mail: ______Business E-mail: ______
List all schools the applicant attended beginning with kindergarten through present school:
______
Siblings: Name ______Age ______School ______
Name ______Age ______School ______
Name ______Age ______School ______
Did the applicant’s sibling (s) attend MDCHS? □ No □ Yes
Name(s) and graduation year ______
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Academic and Behavior Record:
Has the student ever been retained (held back) in any grade level? □ No □ Yes (If yes, please attach an explanation)
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Has the student applicant ever been placed on probation, suspended, expelled, or not allowed to return to any school?
□ No □ Yes (If yes, please attach explanation) ______
Medical History:
Has the applicant ever been tested or counseled by a psychologist or psychiatrist? □ No □ Yes
(If yes, copies of all educational/psychological evaluation must be submitted with this application) ______
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Does this applicant require any accommodations or modifications (physical or instructional) in order to be successful in the regular sitting classroom? □ No □ Yes (If yes, please attach explanation) ______
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Indicate by check any of the following that apply or have applied in the past:
□ Vision Impairment □ Hearing Impairment □ Speech/Language Disorder
□ Specific Learning Disability □ Attention Deficit Disorder □ Behavior Disorder
□ Physical Disability □ Attention Deficit Hyperactivity □ Emotional Disorder
Prescription medication currently taking: ______
Describe any intervention services (including glasses, special aides, etc.) for any of the above. Include any medical information and/or problems and/or required accommodations of which the school should be aware: ______
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Why do you want to send your son or daughter to Monsignor Donovan Catholic High School? ______
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I have read and understand this application, and I further certify that the information and attached documents are complete and accurate to the best of my knowledge. I agree to communicate in writing to the principal any changes contained herein even if said changes occur after enrollment. I understand that upon discovery of substantial inaccuracy of any information herein, or omission of information requested herein, the school reserves the right to revoke admission of this applicant. I waive any right of access to all information from any source in conjunction with my child’s application to Monsignor Donovan Catholic High School.
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Signature of Applicant Date Signature of Parent/Guardian Date
Non-Discrimination Policy
Monsignor Donovan Catholic High School shall admit students of any race, color, sex, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students. Monsignor Donovan Catholic High School shall not discriminate on the basis of race, color, nationality and ethnic origin in the administration of its educational policies, admission policies, scholarship and loan programs, and athletic or other school-administered programs.
Student Questionnaire
Date:______
Name of prospective student: ______
(Please Print) Last First Middle
Applying for grade: ______Current school: ______Current grade: ______
To the prospective student: To learn more about you, we would like you to go over this questionnaire and present thoughtful answers. These questions are as equally as important as report cards and recommendations for the admissions process. Please answer these questions carefully and thoughtfully in your own handwriting, using complete sentences.
1. What co-curricular activities are the most important to you at the present time?
2. What do you consider your greatest talent?
3. What activity do you enjoy the most when you have unlimited time? Why?
4. What are the two best books that you have read recently?
5. Give three adjectives that best describe you.
6. What aspect of yourself would you like to improve upon and why?
7. Which school subjects do you enjoy the most? Which do you enjoy the least?
8. Describe any significant experience you have had. (Example: traveling, meeting another person, overcoming a personal obstacle, etc.)
9. If applicable, name one member of the Donovan community (Student, Alumni, Faculty/Staff, etc.) who has greatly influenced your decision to attend. How has this person impacted your decision?
10. Why do you want to attend Monsignor Donovan Catholic High School?
Monsignor Donovan Catholic High School
590 Lavender Road
Athens, Georgia 30606-1114
RELEASE OF RECORDS
Parents should complete the top portion, sign and return this form to the applicant’s current school Principal, Counselor, or Registrar
To: ______
Principal, Counselor, or Registrar
Date: ______
Name of applicant: ______
Current school: ______
Current grade: ______
Applying for admission to grade: ______
I authorize you to release any information requested by Monsignor Donovan Catholic High School.
Signature of Parent or Guardian: ______Date: ______
The Office of Admissions appreciates your assistance in providing a complete transcript on this applicant. It is necessary that all components be made available to MDCHS in order that the student’s entire application may be considered for admission. Be sure to include the following:
1. A copy of the student’s report cards from grades 6, 7, and 8 (9 and 10 if applicable);
2. A copy of the student’s transcript (if applicable);
3. Academic and behavioral records (including records from any other school that the student attended);
4. All standardized testing records from the past two years (ITBS, CRCT, Stanford, etc.);
5. A copy of the latest Georgia immunization records;
6. A copy of the student’s birth certificate and social security card (if available)
7. Any copies of additional educational or psychological testing that may have been administered.
Please mail or fax completed form and records to: Monsignor Donovan Catholic High School
Admissions
590 Lavender Road
Athens, GA 30606-1114
Fax: 706-433-0229
Thank you for providing this information!
Monsignor Donovan Catholic High School
590 Lavender Road
Athens, Georgia 30606-1114
Mathematics Teacher - School Recommendation Form
(Information on this form is confidential)
To be filled out by the applicant:
Name of applicant: ______Applying to grade: ______
I waive any right of access to information provided on this form.
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Parent/Guardian Signature
To be filled out by recommending school personnel:
Classroom teachers are encouraged to offer their observations of the applicant. Information regarding the applicant’s performance in Math is very helpful to the Admissions Committee. Copies of this form may be made to accommodate the input of more than one teacher. Thank you for your help.
Name of school: ______
Name of person completing form: ______
Grade level: ______Current Math Grade: ______
Course in which the student is currently enrolled: ______
Please characterize applicant’s academic performance in the following categories by placing a check in the appropriate box for each item.
ACADEMIC PERFORMANCE
Excellent
(far exceeds expectations) / Above Average(does more than expected) /
Average
(meets expectations) / Below Average(does not meet expectations)
Works independently
Creativity
Meets deadlines
Class participation
Motivation
Works in groups
Self-confidence
What do you perceive this applicant’s strongest academic attribute in Math to be? ______
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In what area of Math does this applicant need improvement? ______
______
Does this applicant require special accommodations in your class? (if yes, please describe) ______
______
For this applicant’s grade level, rate his/her abilities in the following areas on a scale of 1 to 10, 10 being the highest. Please circle the appropriate number.
Reading comprehension 1 2 3 4 5 6 7 8 9 10
Numerical computation 1 2 3 4 5 6 7 8 9 10
Algebraic skills 1 2 3 4 5 6 7 8 9 10
Overall ability 1 2 3 4 5 6 7 8 9 10
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Please circle the best descriptor for the applicant in each category.
Personal Attributes
Sense of personal integrity / Strong / Moderate / WeakSense of cooperation
/ Strong / Moderate / WeakRespect for authority
/ Age appropriate / Not age appropriateRapport with peers
/ Excellent / Average / Below averageLevel of inquisitiveness
/ High / Moderate / LowTakes responsibility for own actions / Always / Often / Never
Personal initiative
/ Excellent / Average / Below averageOverall Attitude
/ Excellent / Average / Below averageWhat do you perceive this applicant’s strongest personal attribute to be? ______
______
In what areas does this applicant need improvement? ______
______
Please mail or fax this completed form to:
Monsignor Donovan Catholic High School
Admissions
590 Lavender Road
Athens, GA 30606-1114
Fax: 706-433-0229
Thank you for providing this information!
Monsignor Donovan Catholic High School
590 Lavender Road
Athens, Georgia 30606-1114
English Teacher - School Recommendation Form
(Information on this form is confidential)
To be filled out by the applicant:
Name of applicant: ______Applying to grade: ______
I waive any right of access to information provided on this form.
______
Parent/Guardian Signature
To be filled out by recommending school personnel:
Classroom teachers are encouraged to offer their observations of the applicant. Information regarding the applicant’s performance in English is very helpful to the Admissions Committee. Copies of this form may be made to accommodate the input of more than one teacher. Thank you for your help.
Name of school: ______
Name of person completing form: ______
Grade level: ______Current English Grade: ______
Course in which the student is currently enrolled: ______
Please characterize applicant’s academic performance in the following categories by placing a check in the appropriate box for each item.
ACADEMIC PERFORMANCE
Excellent
(far exceeds expectations) / Above Average(does more than expected) /
Average
(meets expectations) / Below Average(does not meet expectations)
Works independently
Creativity
Meets deadlines
Class participation
Motivation
Works in groups
Self-confidence
What do you perceive this applicant’s strongest academic attribute in English to be?
______
______
In what area of English does this applicant need improvement?______
______
Does this applicant require special accommodations in your class? (if yes, please describe) ______
______
For this applicant’s grade level, rate his/her abilities in the following areas on a scale of 1 to 10, 10 being the highest. Please circle the appropriate number.
Reading comprehension 1 2 3 4 5 6 7 8 9 10
Composition 1 2 3 4 5 6 7 8 9 10
Grammar skills 1 2 3 4 5 6 7 8 9 10
Overall ability 1 2 3 4 5 6 7 8 9 10
Please circle the best descriptor for the applicant in each category.
Personal Attributes
Sense of personal integrity / Strong / Moderate / WeakSense of cooperation
/ Strong / Moderate / WeakRespect for authority
/ Age appropriate / Not age appropriateRapport with peers
/ Excellent / Average / Below averageLevel of inquisitiveness
/ High / Moderate / LowTakes responsibility for own actions / Always / Often / Never
Personal initiative
/ Excellent / Average / Below averageOverall Attitude
/ Excellent / Average / Below averageWhat do you perceive this applicant’s strongest personal attribute to be? ______
______
In what areas does this applicant need improvement? ______
______
Please mail or fax this completed form to: