Transcript Release Form Transcript Release Form Parents: Please Give This Form to Your Child's Current School
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ISSL Secondary School Application Transcript Release Form Transcript Release Form Parents: Please give this form to your child's current school. Records must be sent directly from the current school. I/We authorize the release and request the mailing of the following information, if available, of my/our child’s: • grades from the past two school years and the current school year • aptitude and achievement test scores • interpretation of grading scales • psychological and special needs testing results • attendance and disciplinary records • immunization and medical records • current teacher recommendation If accepted, I/We authorize release of the full record when transfer occurs. I/We authorize the school(s) checked to contact schools and other sources to obtain information relative to my/our child’s application. I/We will not seek access to confidential recommendation and evaluation materials before or after the admission decision is made. Applicant’s full name:________________________________________________________________________________________ Last First Middle Applying for grade: ______________________ Enrolling:_________________________ DOB:___________________________ Month/Year Month/Day/Year Current School: ____________________________________________________________________________________________ School Address: ____________________________________________________________________________________________ Street Address City State Zip School phone: ( )_______________________________ School fax: ( ) STATEMENT OF CONFIDENTIALITY: It is the policy of all members of the Independent Schools of St. Louis that all information received regarding a candidate’s application for admission will be treated with complete confidentiality. Only authorized school personnel have access to this information and then only to the extent that the information is relevant to admission and placement decisions. Information received within the scope of this policy is not disclosed to the applicant or to the applicant’s family. Signature(s) of parent(s)/guardian(s): Signature Date Signature Date 7 ISSL 2014-2015 Check the box to the left of each school to which your child is applying and complete the Transcript Release Form on the reverse side. Give this com- pleted form to your child’s school, along with the Common Recommendation Form, on which you ISSL Secondary School Application supplied the applicant’s name and current school. l Chaminade College Preparatory School l Thomas Jefferson School Dianne Dunnig-Gill, Director of Admissions Director of Admissions 425 S. Lindbergh Blvd., St. Louis, MO 63131-2799 4100 South Lindbergh Boulevard Phone: (314) 692-6650 St. Louis, MO 63127 Fax: (314) 993-5732 Phone: (314) 843-4151 Application Deadline: December 19, 2014 (HS) Fax: (314) 843-3527 Application Deadline: January 16, 2015 (MS) Application Deadline: December 12, 2014 (Early Decision) Application Deadline: February 13, 2015 (Regular Decision) l The College School Adrienne Rusbarsky, Director of Admissions l The St. Michael School of Clayton 7825 Big Bend Blvd., St. Louis, MO 63119 Kristin Kuchem, Director of Admission Phone: (314) 962-9355 6345 Wydown Boulevard, St. Louis, MO 63105 Fax: (314) 962-5078 Phone: (314) 721-4422 Application Deadline: February 6, 2015 Fax: (314) 721-4448 Then rolling admissions on a space available basis Application Deadline: January 16, 2015 l Crossroads College Preparatory School l Villa Duchesne and Oak Hill School Maggie Baisch, Director of Admissions Therese Hagemeister, Director of Enrollment Management 500 DeBaliviere, St. Louis, MO 63112 801 S. Spoede Road, St. Louis, MO 63131 Phone: (314) 367-8085 Phone: (314) 810-3446 Fax: (314) 367-9711 Fax: (314) 432-0199 Application Deadline: December 19, 2014 (9th) Application Deadline: November 19, 2014 (9th) Application Deadline: January 16, 2015 Application Deadline: January 16, 2015 l Visitation Academy l John Burroughs School Ashley Giljum, Director of Admissions Caroline LaVigne, Director of Admissions 3020 North Ballas Road, St. Louis, MO 63131 755 South Price Road, St. Louis, MO 63124 Phone: (314) 625-9103 Phone: (314) 993-4040 Fax: (314) 432-7210 Fax: (314) 567-2896 Application Deadline: November 19, 2014 (9th) Application Deadline: December 19, 2014 (9th) Application Deadline: January 16, 2015 Application Deadline: January 16, 2015 l Westminster Christian Academy Peggy Johnson, Director of Admissions l Mary Institute & Saint Louis Country Day School 800 Maryville Centre Dr., Town and Country, MO 63017 Peggy Laramie, Director of Admission Phone: (314) 997-2900 101 North Warson Road, St. Louis, MO 63124 Fax: (314) 997-2903 Phone: (314) 995-7367 Application Deadline: January 16, 2015 Fax: (314) 872-3257 Application Deadline: December 19, 2014 (9th) l Whitfield School Application Deadline: January 16, 2015 (JK-12th) Lou Sabino, Director of Admission 175 South Mason Road, St. Louis, MO 63141 l Saint Louis Priory School Phone: (314) 434-5141 Deacon Tom Mulvihill '80, Director of Admission Fax: (314) 434-6193 500 South Mason Road, Saint Louis, Missouri 63141-8500 Application Deadline: January 16, 2015 Phone: (314) 434-3690, #101 Fax: (314) 514-8374 Application Deadline: January 16, 2015 8 ISSL 2014-2015 ISSL Secondary School Application Section C (School Profile) Applicant’s full name: _______________________________________________________________________________________ Last First Middle Applicant’s current school:______________________________________________________Current grade:________________ SCHOOL PROFILE Your school serves grades: _______ to _______ Number of students in entire school: _________ How large is a typical teaching section?_______ In what month does your school year begin? ___________ End? ____________ Please explain your school’s grading system: Select one: l4.0 Scale l4.3 Scale l1 - 5 l100 - 0 lA - F lOther:__________ lFour Passing Grades lThree Passing Grades lOther (please explain) ___________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ What is the passing mark? _______ Honors mark? _______ STUDENT RECORD Does your school rank its students? lYes lNo This candidate ranks _______ out of _______. How many students share this rank?_________________________________ Are students placed in class/sections according to ability? lYes lNo If yes, please tell us in which level the applicant is placed for each subject. ________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Does your school have a program for special needs students (gifted, learning disabled, etc.) lYes lNo If yes, is this student involved in a program? Name of program: ________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ For how long has this student been involved: Years Months If the student currently has an IEP, please forward the IEP along with student records. 9 ISSL 2014-2015 If the student’s attendance record is not listed on the transcript, please indicate the number of days below: Days absent this year_______ Days absent last year________ Days tardy this year_________ Days tardy last year__________ If the student is not, or has not been in good academic or disciplinary standing, please explain. __________________________________________________________________________________________________ __________________________________________________________________________________________________ Has the student ever been dismissed, suspended, placed on probation, or received other serious disciplinary sanction? lYes lNo If yes, please state the nature of the action taken and describe the circumstances relating to the action. Please provide the names of teachers and/or administrators involved. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Has he or she withdrawn from school voluntarily for an extended period of time for reasons other than health? If yes, please explain the circumstances. ________________________________________________________________________________________________________ ____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Name of person completing this form: ________________________________________________________________________ Print Name Title _______________________________________________________________________________________________________________ Signature Date _______________________________________________________________________________________________________________ Street Address City State Zip (_______)__________________________________________________________________________________________________ Telephone Email Address 10 ISSL 2014-2015.