Application for Admissions

APPLICATION FOR ADMISSION

Application and supporting documents can be submitted

by mail, fax, email or hand delivered to:

Admissions Office

Cristo Rey Baton Rouge Franciscan High School

4000 Saint Gerard Avenue

Baton Rouge, LA 70805

Office: (225) 615-7479

Fax: (225) 615-7532

Cristo Rey Baton Rouge Franciscan High School is a Catholic learning community that educates young people of limited economic means, of any faith or creed, to become men and women for and with others. Through a rigorous college preparatory curriculum, integrated with a relevant work study experience, students graduate prepared for college and life.

Please see reverse side for important checklist

Revised 9/26/16 Page 4 of 4

APPLICATION CHECKLIST

Dear Students and Parents/Guardians:

To be considered for admission to Cristo Rey Baton Rouge Franciscan High School, students must submit all of the documents listed below. Once all documents have been received, and if the Admissions Committee needs additional information, the student and parent/guardian will be contacted to schedule an interview. A complete admission file is required in order to be reviewed by the Admissions Committee. It is the parent’s responsibility to check with the Admissions Office to confirm that your child’s file is complete.

1.  Submit the following items directly to the Cristo Rey Admissions Office:

(hand deliver, mail, fax or scan/email to address on reverse side)

Completed Application for Admission along with the following documents:

□ Most recent W-2 of each adult in household

□ Most recent Income Tax Return (1040 or 1040A) of each adult in household. If no taxes filed, submit

Employment Letter and any other proof of income.

v  If applicable, copy of documentation for the following forms of income: Social Security Income(SSI), Welfare/TANF, Child Support, Food Stamps, Worker’s Compensation, Pension Income, Disability Income Subsidy, Student Loans or Grants received, Foster Care, Housing, Assistance for Parent’s or Guardian’s education

□ Completed TADS Financial Aid Application Form

□ Appropriate government document to confirm age (i.e., birth certificate, passport, etc.)

□ Student Photo

*The above items are necessary to prequalify your student to continue the admissions process.

2.  Submit the following to your child’s current school:

(Parents or guardians need to sign the Request of Records Form and each Teacher Evaluation Form

before they are given to the student’s school)

Request for Records Form

English Teacher Evaluation Form

Math Teacher Evaluation Form

*The student’s current school should mail these items directly to the Admissions Office at

4000 Saint Gerard Avenue, Baton Rouge, LA 70805. Or, they can be faxed to (225) 615-7532

or emailed to

**All evaluation forms must be completed by a teacher or academic staff. If a student is homeschooled, the student must provide recommendation forms from adults who can attest to the student’s academic performance and behavior. Parents

or Guardians cannot complete the evaluation forms.

APPLICATION INSTRUCTIONS
§  Please type or print clearly
§  Use blue or black ink
§  Fill in all blanks / OFFICE USE ONLY
Date Received:
Date Processed:
Date Accepted:

Employment Eligibility Disclaimer

As a member school of the national Cristo Rey Network, Cristo Rey Baton Rouge’s Corporate Work Study Program provides students with real world experiences and allows them to earn a portion of the cost of their education. A positive attitude and a commitment to high standards of responsibility and behavior are required. All students must be 14 years of age on or before September 5 of their freshman year and be eligible to work legally in the United States.

SECTION A: STUDENT’S PERSONAL DATA

First Name Middle Initial Last Name

Date of Birth (MM/DD/YYYY): ______Birthplace (City and State) ______

*All prospective students must be 14 years of age on or before September 5th of their freshman year.

Home Address: Gender: Male Female

Street Apt. City State Zip Code

County: ______Student’s email: ______

Language spoken at home: ______Other Language Spoken: ______

Will the student be authorized to work in the U.S. by the first day of the work study program, Sept 5? Yes No

**Students of all faith traditions are welcome to apply**

Religion: Roman Catholic Christian Muslim Hindu None Other ______

The following two questions are needed for Federal reporting:

Ethnicity: Hispanic/Latino Non-Hispanic/Latino

Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more)

Race: Black/African-American (including Africa and Caribbean) White/Caucasian (including Middle Eastern)

Asian (including Indian subcontinent and Philippines) Native Hawaiian/Other Pacific Islander (Original Peoples)

American Indian/Alaska Native (including all Original Peoples of the Americas)

How did you hear about Cristo Rey Baton Rouge Franciscan High School? Please mark all that apply.

Friend Current Student or Parent Odyssey La Amistad Television

Church Sibling of Current Student Breakthrough Atlanta First Tee Radio

Current School Boys & Girls Club Keeping Pace C-5 Georgia

YMCA Big Brother/Big Sister Reach for Excellence Girls Inc.

Please write the name of the person, church or program that referred you to Cristo Rey:

______

Is your son or daughter currently attending a camp, after school program and/or enrichment program? Yes No

Name of Program: ______

SECTION B: STUDENT BACKGROUND

List all schools the student has attended in the last three years

Current School City, State Year(s) Attended

(1)
(2)
(3)

Learning and Medical Profile (the information you provide is confidential)

Please describe the student’s personal strengths and weaknesses.

Has the student experienced any behavioral issues or demonstrated any violent, disruptive or disrespectful behavior in school? Please explain.

Does the student suffer from any serious illness, physical or emotional limitation, depression, or other mental illness? Please explain.

1.  Has the student ever been arrested or convicted of a crime? Yes No

2.  Has the student ever had a psycho-educational evaluation? Yes No

3.  Has the student been tested for, or diagnosed with a learning disability? Yes No

4.  Has the student been tested for, or diagnosed with ADD or ADHD? Yes No

5.  Has the student now or ever been enrolled in special education classes? Yes No

6.  Does the student currently have or ever had and Individual Education Plane (IEP)

or 504 plan? Yes No

If you answered YES to any of the questions above, please explain on a separate sheet of paper.

Copy of Psycho-Educational Evaluation, IEP or 504 must be attached to this application.

SECTION C: FAMILY INFORMATION

The student lives with: (please mark all that apply)

Both Parents Mother Only Father Only Grandparents Aunt or Uncle Legal Guardian Other______

Parents’ current marital status

Married Divorced Separated Single Parent Widowed Living Together

Dependents living in household: Number of Adults ______Number of Children ______

Please list all family members living in your home (please include name and age)

______

______

Personal Data of Parent #1 or Legal Guardian #1

Gender: / Male / Female

First Name M.I Last Name

Relationship to Student: / Mother Father Step-Parent Legal Guardian / If Legal Guardian, what is your relationship to the student:
Home address, if different from student’s home address:

Street Apt. City State Zip Code County

Cell phone number: ______Employer: ______

Work phone number: ______Occupation: ______

Email address: ______Work status: Employed Unemployed Self-employed Homemaker

Disabled Student Retired

Personal Data of Parent #2 or Legal Guardian #2

Gender / Male / Female

First Name M.I Last Name

Relationship to Student: / Mother Father Step-Parent Legal Guardian / If Legal Guardian, what is your relationship to the student?
Home address, if different from student’s home address:

Street Apt. City State Zip Code County

Cell phone number: ______Employer: ______

Work phone number: ______Occupation: ______

Email address: ______Work status: Employed Unemployed Self-employed Homemaker

Disabled Student Retired

SECTION D: PARENT OR GUARDIAN QUESTIONNAIRE

Why do you want your son or daughter to attend Cristo Rey Baton Rouge Franciscan High School?

Why do you believe he or she would do well here?

SECTION E: EMERGENCY CONTACT (Not Parent)

In case of emergency and I cannot be reached, please contact the emergency contact provided below

Contact #1

Full Name: / Relationship to the student:
Telephone number: / E-mail Address:

Contact #2

Full Name: / Relationship to the student:
Telephone number: / E-mail Address:

IMPORTANT NOTE TO PARENTS OR GUARDIANS: (please review carefully and sign below)

I understand that Cristo Rey Baton Rouge Franciscan High School is an academically challenging, Catholic school with a code of mandatory attendance, dress, and conduct. I further understand that full participation of parents and guardians is necessary in order to fulfill requirements of the program.

Student Signature Date

Parent/Guardian Signature Date

Admission to Cristo Rey Baton Rouge Franciscan High School is contingent upon successful completion of the student’s current Grade (passing grades in all courses and no further disciplinary actions by end of the year). I certify that the information furnished in this application is complete and accurate. Furthermore, I understand that if I knowingly provide false information, this may jeopardize my child’s application.

Parent/Guardian Signature Date

Cristo Rey Baton Rouge Franciscan High School admits students of any gender, race or ethnic origin to all the rights, privileges, programs, and activities made available at the school. We do not discriminate on the basis of gender, race, or ethnic origin in the administration of our educational

policies related to scholarship opportunities, tuition assistance, athletics and other school-administered programs.

Revised 9/26/16 Page 4 of 4