Application for Admission
2014-2015 School Year
Mail or deliver applications to:
Admissions Office
Cristo Rey Columbus High School
840 West State Street
Columbus, Ohio 43222
Phone: (614) 223-9261 x 227
[email protected]
Cristo Rey Columbus High School 2013-2014 Admissions Process Deadlines for Applications
Early Admission Deadline………..………Thursday, December 5, 2013
Regular Admission…………..….………….……..Thursday, February 13, 2014 Part 1- Application
In order for your application to be processed, your file must include the following items:
Application for Admission (this form)
Student must be age 14 before September 1, 2014 Student must be eligible to work in the United States
Submit Request for Records form to student’s current school requesting:
• Completed Recommendation Form from English teacher
• Completed Recommendation Form from Math teacher
• Completed School Leader or Community Leader Recommendation Form
• Copy of Report Cards, discipline records, and attendance records from grades 6-8
• Copy of Standardized Test scores from grades 6-8
• IEP/ISP records, if applicable
Financial Aid Forms
• FACTS Tuition Aid Application (must include $30 processing fee)
• Ohio EdChoice Scholarship application Part 2- Interview
Applicants who complete their applications may move into the second phase of the admissions process. Applicants who meet the criteria to be a Cristo Rey Columbus student may be invited to interview with the Director of Admissions or other school representative.
Student and Family interview with the Director of Admissions or other school representative
Part 3 – Math and Writing Exams
Applicants will also take a math and writing exam. Dates for testing TBA.
For Accepted Students only
Part 3- Registration
The Admissions Committee will mail out the first round of decisions on December 31, 2013.
Students who are accepted and plan to attend Cristo Rey Columbus must register to secure their placement in the class.
Register at Cristo Rey Columbus and submit $50 Registration Fee
APPLICATION INSTRUCTIONS OFFICE USE ONLY
• Please type or print clearly.
• Use blue or black ink.
• Fill in all blanks provided.
Date Received _________
Staff Receiving _________
SECTION A: STUDENT’S PERSONAL DATA Full Name (as on Birth Certificate):
Last First Middle Initial
8th Grade School: Religion (optional):
Birth Date: / /
Month Day Year
Please mark racial and/or ethnic identity (optional)
Black or African American Caribbean Islander Hispanic or Latino
Asian White Other __________________
Home Address:
Address Apt. City State Zip
Home Phone: - - Birth Place:
Gender : Male Female
Language spoken at home: Other Languages Spoken:
Student’s Cell Phone (optional): - - Student Lives With: (Check all that apply.)
Mother Father Both Parents Grandmother Grandfather Aunt or Uncle Foster Care Provider Other–Relationship: _____________________________________
Parent/Guardian’s Current Marital Status: (Check all that apply.)
Single Parent Parents Married Parents Together Divorced Separated Mother Remarried
Father Remarried Mother Deceased Father Deceased Under DYFS Custody
SECTION B: STUDENT QUESTIONNAIRE
This must be completed in student’s own handwriting, without parental assistance. If needed, use additional paper or the back of this page.
Student Name: _______________________________ Date: _______________________
Give an example of a time when you struggled with something (academic or non-academic related) and how you handled the situation:
Do you know any current Cristo Rey students? If so, who?
___________________________________________
__________________________________________________________________________________________
How did you hear about Cristo Rey Columbus? (check all that apply)
☐ Cristo Rey Representatives visited my school ☐ Cristo Rey Representatives visited my church
☐ Friend, neighbor, or relative ☐ Teacher, counselor, or clergy ☐ Community event (festival, fair, etc.)
☐ Received something in the mail ☐ Received a phone call ☐ Newspaper Article ☐ Radio Ad
What high school would you attend next year if you do not attend Cristo Rey Columbus?
What is your district home high school?
Please list three words you would use to describe yourself:
SECTION C: FAMILY INFORMATION (to be completed by parent or guardian) Personal Data of Parent or Guardian 1
Full Name:
Last First Middle Initial
Gender: Male Female English Speaker: Yes No
If no, list preferred spoken language: __________________
Relationship to Student: Legal Guardian? Yes No Home Address:
Address Apt. City State Zip
Home Phone: - -
Work Phone: - -
Employer: Occupation:
Parent Cell Phone: - -
Please check the best way to contact you.
______ Work Phone ______ Home Phone ______ Cell Phone ______ Text Message
______ Email
If email is a preference, please write your email address: ________________________________
Personal Data of Parent or Guardian 2 Full Name:
Last First Middle Initial
Gender: Male Female English Speaker: Yes No
If no, list preferred spoken language: __________________
Relationship to Student: Legal Guardian? Yes No Home Address:
Apt./Street City State Zip
Home Phone: - -
Work Phone: - -
Employer: Occupation:
Parent Cell Phone: - -
Please check the best way to contact you.
______ Work Phone ______ Home Phone ______ Cell Phone ______ Text Message
______ Email
If email is a preference, please write your email address: ________________________________
SECTION D: PARENT QUESTIONNAIRE (to be completed by parent or guardian) List all schools the student has attended in the last THREE years:
(1)
Current School City, State Year(s) Attended
(2)
School City, State Years(s) Attended
(3)
School City, State Years(s) Attended
(4)
School City, State Year(s) Attended
Learning and Medical Profile
Has the student been diagnosed with a learning disability? Yes No Has the student been diagnosed with ADD or ADHD? Yes No Has the student now or ever been enrolled in special education classes? Yes No Has the student been enrolled in English as a Second Language (ESL) classes? Yes No
Does the student currently have, or ever had, an Individual Education Plan (IEP)? Yes No If Yes, a copy of the IEP must be included with the application.
If you answered YES to any of the questions above, please explain below.
Why do you want your son or daughter to attend Cristo Rey Columbus?
Why do you believe he or she would do well here?
Household Income
How many adults live in your house? ______ Relationship(s) to child:
_________________________________
How many children live in your house? ______ Relationship(s) to child:
________________________________
Please check the most appropriate range of your total household income.
Less than $20,000 $20,001-40,000 ______$40,001-60,000 $60,001-80,000 _____ Higher than $80,000
* All applicant families are required to complete the FACTS Financial Application before receiving an official admissions decision from Cristo Rey Columbus.
IMPORTANT NOTE TO STUDENTS, PARENTS AND GUARDIANS:
Please review carefully and sign below.
I understand that Cristo Rey Columbus High School is an academically challenging, Catholic school with a code of mandatory attendance, dress, and conduct. The hallmark of the school is its Professional Work-Study Program in which the students work one full day each week and a fifth day during the course of every month of the school year, excluding holidays and days when school is closed. I understand the student’s earnings will be assigned to the Professional Work-Study Program to fund a portion of the cost of their high school education. I further understand that full participation of parents and guardians is necessary in order to fulfill requirements of the school.
Admission to Cristo Rey Columbus High School is subject to our receipt of an official transcript
demonstrating successful completion of the applicant’s current grade and satisfactory completion of our mandatory summer professional training program. Admission and enrollment decisions are made at the sole discretion of Cristo Rey Columbus administration. I certify that the information furnished in this application is complete and accurate. Furthermore, I understand that if I knowingly provide false information, my child’s admissions may be jeopardized.
Student Signature Date
Parent/Guardian Signature Date
NOTA IMPORTANTE PARA ESTUDIANTES, LOS PADRES O REPRESENTANTES:
Por favor revise cuidadosamente y firme a continuación.
Comprendo que la Escuela Secundaria Cristo Rey de Columbus es una escuela católica con un riguroso programa académico. que posee un código de asistencia mandatoria, vestimenta y conducta. La marca que diferencia está escuela es su Programa Profesional de Trabajo-Estudio en el cual los estudiantes trabajan un dáa entero cada semana y un quinto dáa durante cada mes del año escolar, con excepción de los dáas feriados y los dáas en que no haya clase. Comprendo que lo que gane cada estudiante se asignará al Programa Profesional de Trabajo-Estudio para financiar parte del costo de su educación secundaria. Afirmo que comprendo que la participación total de los padres y representantes es necesaria para cumplir los requisitos de la escuela.
La admisión a la Escuela Secundaria Cristo Rey de Columbus está sujeta al recibo de un certificado académico oficial que demuestre que el aspirante completó satisfactoriamente el grado actual y nuestro campamento de verano obligatorio. Las decisiones de admisión e inscripción se realizan
exclusivamente a discreción de la administración de Cristo Rey de Columbus. Certifico que la
información proporcionada en esta aplicación es completa y precisa. Y, además, afirmo que si proveo informacion falsa, la admisión de mi hijo(a) será perjudicada.
Firma del Estudiante Fecha
Firma del Padre Fecha
