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 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 2013-2014 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 Matthew Saxer, Director of Admissions Jane Roth, 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 18, 2013 (HS) Fax: (314) 843-3527 Application Deadline: January 31, 2014 (MS) E-mail: [email protected] l The College School l The St. Michael School of Clayton Adrienne Rusbarsky, Director of Admissions Kristin Kuchem, Director of Admission 7825 Big Bend Blvd., St. Louis, MO 63119 6345 Wydown Boulevard, St. Louis, MO 63105 Phone: (314) 962-9355 Phone: (314) 721-4422 Fax: (314) 962-5078 Fax: (314) 721-4448 Application Deadline: February 7, 2014 Application Deadline: January 17, 2014 Then rolling admissions on a space available basis l Villa Duchesne and Oak Hill School Therese Hagemeister, Director of Enrollment Management l Crossroads College Preparatory School Maggie Baisch, Director of Admissions 801 S. Spoede Road, St. Louis, MO 63131 500 DeBaliviere, St. Louis, MO 63112 Phone: (314) 810-3446 Phone: (314) 367-8085 Fax: (314) 432-0199 Fax: (314) 367-9711 Application Deadline: November 20, 2013 (9th) Application Deadline: January 17, 2014 Application Deadline: January 17, 2014 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 20, 2013 (9th) Application Deadline: January 17, 2014 Application Deadline: January 17, 2014 l Mary Institute & l Westminster Christian Academy Saint Louis Country Day School Peggy Johnson, Director of Admissions Peggy Laramie, Director of Admission 800 Maryville Centre Dr., Town and Country, MO 63017 101 North Warson Road, St. Louis, MO 63124 Phone: (314) 997-2900 Phone: (314) 995-7367 Fax: (314) 997-2903 Fax: (314) 872-3257 Application Deadline: January 17, 2014 Application Deadline: January 17, 2014 (JK-12th) l Whitfield School l Saint Louis Priory School Lou Sabino, Director of Admission Deacon Tom Mulvihill, Director of Admission 175 South Mason Road, St. Louis, MO 63141 500 South Mason Road, Saint Louis, Missouri 63141-8500 Phone: (314) 434-5141 Phone: (314) 434-3690, #101 Fax: (314) 434-6193 Fax: (314) 514-8374 Application Deadline: January 17, 2014 (Early Decision) Application Deadline: January 17, 2014 Application Deadline: January 17, 2014 (Regular Decision) 8 ISSL 2013-2014 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 2013-2014 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 2013-2014.