Registration Packet 2018-2019 School Year - Saint Jerome Catholic ...

 
Registration Packet 2018-2019 School Year - Saint Jerome Catholic ...
“We see God in all and respond with compassion and service.”

       2018-2019 School Year
         Registration Packet

                   Mr. Javier Bravo, MA Ed.
                           Principal

                        Fr. Gary Regula
                             Pastor

                    Fr. Rayison Jose, Sch.P.
                        Parochial Vicar

                      Mr. Harry Plummer
               Superintendent of Catholic Schools
             Roman Catholic Diocese of Phoenix, AZ
January 8, 2018

Dear Families,

Thank you for choosing St. Jerome Catholic School for your child(ren). In the Apostolic Letter Evangelization
through Catholic Schools Bishop Thomas J. Olmsted outlines the role of a Catholic Education in the formation of
students and in our calling to engage in evangelization. The resurrection account in the Gospel of St. Matthew
relates how Christ issues the Great Commandment to his disciples: “Go, therefore, and make disciples of all
nations, baptizing them in the name of the Father, and of the Son, and of the Holy Spirit, teaching them to observe
all that I have commanded you.”(Mt. 28:19-20). The Catechism of the Catholic Church relates that “those who
with God’s help have welcomed Christ’s call and freely responded to it are urged on by love of Christ to proclaim the
Good News everywhere in the world.” (CCC 3, emphasis added) Thus it is clear that the mission of the school is an
extension of the salvific mission of the Church by making Christ known to all through forming the intellect of
students to engage in the New Evangelization.

St. Jerome Catholic School embraces the curriculum and standards set forth by the Catholic Schools Office of the
Roman Catholic Diocese of Phoenix and engages with students in the disciplines of Mathematics, Science, Social
Studies, Language Arts, Reading, Religion, Physical Education, Spanish Language and Culture, and the Fine Arts
to form the intellect of our students in a manner that will help them to know the truth and pursue the good. At.
St. Jerome Catholic School:
      We believe that every child we encounter has a unique purpose and a specific talent that, once discovered
         and developed, will enrich the greater community.
      We assist children in discovering their uniqueness through developing them into faith-filled, life-long
         learners who are complex thinkers and effective communicators.
      We are a Catholic school who accomplishes our vision under the patronage of St. Jerome.

Once again, I thank you for considering St. Jerome Catholic School. The office staff and I are open to answering
any question you may have regarding our school, its traditions, and the registration process. Please do not
hesitate to ask any questions you may have.

May St. Jerome, our patron, intercede for you and your family as you continue this registration process.

St. Jerome, pray for us!

Sincerely,

Mr. Javier Bravo, MA Ed.
Principal
Preschool Program
The Preschool Program at St. Jerome Catholic School licensed by the State of Arizona. The
curriculum of the Preschool program utilizes the diocesan standards based off of the Early
Learning Standards issued by the Arizona Department of Education. Curriculum content covered
in the Early Learning Standards include:
     Social Emotional Standards
     Approaches to Learning Standards
     Language and Literacy Standards
     Mathematics Standards
     Science Standards
     Social Studies Standards
     Physical Development and Safety Standards
     Fine Arts Standards
     Religious Instruction Standards

The Preschool Program is a FULL DAY program. The daily schedule is:
    Monday – Thursday: 7:50 am – 3:00 pm
    Friday: 7:50 am – 1:00 pm
The school day at St. Jerome Catholic School is flanked by prayer meaning that it begins with
Morning Prayer and ends with the End of the Day prayer as well as classroom opportunities for
personal intentions.

To qualify for the Preschool Program, children must have already had their third birthday before
September 1st of each school year. Children must be able to understand classroom instructions in
the English language and be fully and independently potty trained.
Pre-Kindergarten Program
The PreK Program at St. Jerome Catholic School licensed by the State of Arizona. The curriculum
of the Preschool program utilizes the diocesan standards based off of the Early Learning Standards
issued by the Arizona Department of Education. Curriculum content covered in the Early
Learning Standards include:
     Social Emotional Standards
     Approaches to Learning Standards
     Language and Literacy Standards
     Mathematics Standards
     Science Standards
     Social Studies Standards
     Physical Development and Safety Standards
     Fine Arts Standards
     Religious Instruction Standards

The PreK Program is a FULL DAY program. The daily schedule is:
    Monday – Thursday: 7:50 am – 3:00 pm
    Friday: 7:50 am – 1:00 pm
The school day at St. Jerome Catholic School is flanked by prayer meaning that it begins with
Morning Prayer and ends with the End of the Day prayer as well as classroom opportunities for
personal intentions.

To qualify for the PreK Program, children must have already had their fourth birthday before
September 1st of each school year. Children must be able to understand classroom instructions in
the English language and be fully and independently potty trained.
Admissions Process for St. Jerome Catholic School
The entire admissions process at St. Jerome Catholic School consists of two parts: Registration
and Enrollment.
     Part I – REGISTRATION: The following documents and fee from the school
       Registration Packet are needed to complete the registration process. A potential student will
       not be considered “registered” until all of the following have been submitted to the School
       Office:
          o Registration form
          o Non-refundable Registration Fee of $150 (Per Family)
          o Original Birth Certificate and Sacrament Certificates (If applicable)
          o Arizona Public School Enrollment Verification Form – This form will need to be
               scanned in to scholarship applications
          o Immunization records
          o Health history
          o ADHS Emergency Contact Form
          o Emergency Card (Blue)
          o Diocese of Phoenix Custodial Agreement
          o Final Report Card from previous school – The final report card must show the
               grades for all 4 quarters
                    This documentation is not needed for new Preschool, Pre-K and
                      Kindergarten Students
          o Standardized Test results from previous school (i.e. AZ Merit or ITBS) when
               available
          o Create a FACTS account and submit proof of account
                    FACTS is an online tuition management system. When a family receives a
                      scholarship or financial aid, the amount received must be applied to the
                      tuition amount. This can only be done in the FACTS online tuition
                      management system
          o Apply for financial aid through Catholic Education Arizona and AZ4Education –
               submit proof of completion
          o Apply for a minimum of four (4) other tax credit organization scholarships – submit
               proof with packet
                    For proof, tax credit organizations will email a verification to the family when
                      they submit their application. A print out of the verification is sufficient for
                      proof of completion. (Sample Attached)
The school will contact families who are missing pieces of the registration packet to assist them in
completing the packet. Once the school has received a complete packet the school will move on to
the second part of the admissions process.
 Part II – ENROLLMENT
     o The principal will review all documents and make an enrollment decision
     o Students who have a failing grade in a Core Course may be required to meet with the
          principal prior to an enrollment decision.
               Note: If the previous report card and standardized test scores are not received
                 with the registration packet, the admission decision will be placed on hold
                 and your student will remain in “Registered” status but not “Admitted”
                 status.
     o The school will send out an Enrollment Letter indicating the potential student’s
          enrollment status.
     o One of the following three statuses will be listed in the Enrollment Letter:
               Enrolled – The student is now a part of St. Jerome Catholic School
               Waiting List – The grade where the student is to be enrolled is currently as
                 maximum capacity
               Not Enrolled – The student’s application is rejected.
     o If there is a waiting list for your student’s grade and another student submits all
          necessary documents, the spot will go to the next student in line who has all
          documents submitted.
2018-2019 Tuition Commitment Form
                           All Families must have a FACTS Payment Plan Created
                       Register for FACTS at https://online.factsmgt.com/signin/46FLW
                                     Yearly             Semester             Quarterly             10 Month                12 Month
          Family                      Plan                Plan                   Plan                 Plan                    Plan
          Status                      July           July & January        July, October,         July - April             July - June
                                                                           January, April

  Catholic Parishioner
   Verified by Parish

          1 Child                     $5,800             $2,900                $1,450                 $580                 $483.34

         2 Children                  $10,600             $5,300                $2,650                $1,060                 $883.34

         3 Children                  $14,400             $7,200                $3,600               $1,440                  $1,200
Every student over 3 will be at a cost of $3,800 each.
   Non-Catholic Rate

          1 Child                       $7,100           $3,550                $1,775                 $710                 $591.67

          2 Children                  $13,200            $6,600                $3,300               $1,320                  $1,100

          3 Children                  $18,300            $9,150                $4,575               $1,830                  $1,525
                                Register for FACTS at https://online.factsmgt.com/signin/46FLW
                                 All families must be registered for FACTS automatic payment plan.
                    Any remaining balance from the 2017-2018 school year must be resolved prior to re-enrollment

    I wish to pay my annual tuition using the following plan (Please circle in the table and check the selection below):
    __________Yearly Plan (July)                                   __________10 Month Plan (July – April)
    __________Semester Plan (July & January)                       __________12 Month Plan (July – June)
    __________Quarterly Plan (July, October, January, April)

    I have read, and agree to abide by the financial policies of St. Jerome Catholic School as included in this information and in
    the Parent Handbook. I understand that the tuition payment plan I have selected will obligate me to a specific monthly
    payment as listed in the chart above. I understand that the first payment is due in July before the start of the school year. I
    understand that I must inform the school if there are any changes to FACTS and that any holds on payments must be
    approved by the Principal AND the Pastor. I also understand that my student cannot be enrolled unless the parent has an
    active FACTS account.

    ____________________________________ ____________________________ _______
    Parent Signature                       Printed Last Name           Date
FUNDING A CATHOLIC EDUCATION
                          IN THE STATE OF ARIZONA

All families wanting to register a student at St. Jerome Catholic School must complete a minimum
of 6 tax credit scholarships as part of the registration process.

There are two required tax credit scholarships that all families must complete:
  1. Catholic Education Arizona - http://catholiceducationarizona.org/applicant/ (application
      opens on February 1, 2018)
  2. Arizona Education Scholarship Foundation Inc. - http://www.az4education.org/
      (application currently open)

Other Tax Credit Scholarship Organizations include but are not limited to:
    Brophy Community Foundation
    Arizona School Choice Trust
    Arizona Leadership Foundation
    Institute for Better Education
    Arizona Scholarship Fund
    Tuition Organization for Private Schools (TOPS)
    School Choice Arizona
    Arizona Private Education Scholarship Fund
    White Mountain Tuition Organization
    AZ Yes (Youth Education Scholarships)
    AAA Scholarships
    Arizona Tax Credit
    Arizona Tuition Connection

Other organizations included in the next page.

REMINDER: Scholarship awards can only be applied to tuition if the family has a FACTS
account set up.
SCHOOL TUITION ORGANIZATION RESOURCE LIST

 School Tuitio n                                      Applicatio n                Disabled/                        Accepts Student
  Organizatio n                  Website                 Fee         Corpo rate   Displaced   Individual   Plus   Reco m mendatio ns                 Other Info rmatio n
                                                                                                                                         An AAA family may not accept a scholarship
                                                                                                                                              from more than one School Tuition
AAA Scholarship
                            aaascholarships.org           $30           Yes         Yes          No        No            No              Organization for the same school year. It may
  Foundation
                                                                                                                                          be easier to do a paper application than an
                                                                                                                                                           online app.

     Arizona
                                                                                                                                       Awards scholarships for both tuition and other
   Community                 azfoundation.org             free          Yes         Yes          Yes       Yes           No
                                                                                                                                       school expenses (at hletic fees, uniforms, etc).
   Foundation

     Arizona
    Education
                             az4education.org             free          No          Yes          Yes       Yes           Yes                     Monthly award distribution.
   Scholarship
   Foundation

                                                                                                                                       Incomplete or incorrect applications require an
    Arizona
                                                                                                                                        entirel y new application to be submitted. Be
   Leadership                arizonaleader.org            free          Yes         Yes          No        No            No
                                                                                                                                       sure to check to be sure your application has been
   Foundation
                                                                                                                                                     accepted as complete.

 Arizona Private                                                                                                                        Monthly disbursements. Do not require a copy
   Education                     apesf.org                free          Yes         Yes          Yes       Yes           Yes            of tax return at the time of application. General
Scholarship Fund                                                                                                                              fund awards are usually made in June.

                                                                                                                                          Family must meet income qualifications.
 Arizona School
                                 asct.org                 $30           Yes         Yes          Yes       Yes           No             Application fee. Will only accept the first 2000
  Choice Trust                                                                                                                              applications. First come, first served.

                                                                                                                                         Provides an individualized "Launch page” for
 Arizona Tuition
                       arizonatuitionconnection.com       free          Yes         Yes          Yes       Yes           Yes               your family free of charge. No tax return
   Connection
                                                                                                                                                required at time of application.

     Catholic                                                                                                                          Supports Catholic schools within the Diocese of
    Education                  fairapp.com                $27           Yes          No          Yes       Yes           No               Phoenix. Available funds designated to St.
     Arizona                                                                                                                              Jerome Catholic School. Need based awards.

                                                                                                                                             Monthly recommended student award
Institute for Better
                            ibescholarships.org           free          Yes         Yes          Yes       Yes           Yes              distribution. General fund awards in June of
    Education                                                                                                                                              each year.

   Pappas Kids
                                                                                                                                       Family must meet income qualifications for free
   Schoolhouse               pappaskidssf.org             free          Yes          No          Yes       Yes           No
                                                                                                                                       and reduced lunch. Submit a paper application.
   Foundation

                                                                                                                                        General fund awards are distributed in August.
  School Choice
                          schoolchoicearizona.org         free          Yes         Yes          Yes       Yes           Yes            Student recommended funds are distributed in
     Arizona                                                                                                                                  April for the current school year.

 School Tuition
 Assn of Yuma                                                                                                                          Primarily supports Yuma schools but may have
                               Azstay.org                 free          Yes         Yes          Yes       Yes           Yes                      funds available for others

 Scholarships for
   Educational
   Excellence
   Foundation                   seefaz.org                free          No           No          Yes       Yes           Yes

  Tops for Kids              topsforkids.com              free          No           No          Yes       Yes           Yes                      Tri-annual disbursements
2018-2019
                                               REGISTRATION FORM
                                              Your Child’s Information

First name (as in birth certificate) ______________________ Middle: _______________________
Last name (as in birth certificate) ________________________ Birth Date: ___/____/_______
Current age: ____________ Social Security Number: _____________________________________
Mailing Address: ________________________________________________________________
City, State, Zip Code: _____________________________________________________________
Sex: ☐Male or ☐Female                  Country of birth: ________________________________________
Family/Home Email: _____________________________________________________________
Family/Home Phone Number: ______________________________________________________
Race:      ☐Alaska/American Indian ☐Asian ☐Black/African American ☐Native Hawaiian/Pacific Islander
           ☐White/Caucasian               ☐Two or more races                      ☐Unknown
Ethnicity:        ☐Hispanic               ☐Non-Hispanic
                                                    Family Information
Name: ______________________________ Relationship to child: _________________________
Address: ______________________________________________________________________
City: _____________ State: _____ Zip Code: ________ Parish Affiliation: ____________________
Occupation: ________________________ Company Name: _______________________________
Home Phone: _____________________                          Cell Phone: _________________________________
Work Phone: ____________________ Primary E-mail: ___________________________________
My information may be included in the school directory ☐ Yes ☐ No
Name: ______________________________ Relationship to child: _________________________
Address: ______________________________________________________________________
City: _____________ State: _____ Zip Code: ________ Parish Affiliation: ____________________
Occupation: ________________________ Company Name: _______________________________
Home Phone: _____________________                          Cell Phone: _________________________________
Work Phone: ____________________ Primary E-mail: ___________________________________
My information may be included in the school directory ☐ Yes ☐ No
Marital status of parents: ☐ Married ☐ Divorced ☐ Separated ☐ Single                                         ☐Widowed
Child’s primary residence is with: ☐ Mother    ☐ Father      ☐Split custody
Note: if parents are divorced or separated, court documents clarifying custody situation and educational rights must be submitted to the
school office.
Family Information cont.

Siblings:
         _________________________________               _______
         Name                                            Age   Attends St. Jerome Catholic School: ☐ Yes ☐No
        _________________________________                _______
        Name                                             Age   Attends St. Jerome Catholic School: ☐ Yes ☐No
        _________________________________                _______
        Name                                             Age   Attends St. Jerome Catholic School: ☐ Yes ☐No
        _________________________________                _______
        Name                                             Age   Attends St. Jerome Catholic School: ☐ Yes ☐No

Language (other than English) spoken at home: _________________________________________________________

                                         Religious Background

Parents are: ☐Catholic ☐Non-Catholic              Student applicant is: ☐Catholic ☐Non-Catholic
Registered Parish: ________________________________               Location: ____________________________
Baptism: __________________________________________                       ______________________________
                    Church Name                                           City & State

First Penance: __________________________________________ ____________________________
                      Church Name                         City & State
First Communion: _______________________________________ ____________________________
                     Church Name                         City & State

Confirmation: __________________________________________ ____________________________
                     Church Name                         City & State

                                          Academic Information
(Preschool, Pre-K or Kindergarten applicants include day care experiences):
1) Last School Attended: _________________________________________________________________
Date Enrolled: ___________Date Withdrawn: _________
Reason for leaving: _____________________________________________________________________
2) Last School Attended: _________________________________________________________________
Date Enrolled: ___________Date Withdrawn: _________
Reason for leaving: _____________________________________________________________________
If your child is transferring from a Catholic School that is part of the Roman Catholic Diocese of Phoenix, is there
any outstanding tuition owed to the previous school?
☐ No Yes ☐               Diocesan policy does not allow students to re-enroll in a different Catholic school when
there is tuition owed to the previous school.

Has your child ever been suspended, expelled, dismissed, or not allowed to re-enroll in a school?
☐ No Yes ☐            If yes please provide the name of the school and the reasons on a separate sheet of paper.

Has your student ever been tested or evaluated for any disability [i.e., earning disabilities, ADD/ADHD, emotional
disabilities, etc.], English as a Second Language, or medical condition? ☐ No ☐ Yes

If yes, please describe on a separate sheet of paper any disability or medical condition that may affect your child’s
ability to fully participate in the academic program provided at St. Jerome Catholic School . If you are requesting an
adjustment or accommodation to the curriculum, please describe your request.
Information about disabilities is requested for the sole purpose of determining whether the school can provide the
applicant with an appropriate education or reasonable accommodation and will not be considered in determining
whether he/she is otherwise qualified for admission. Please note: St. Jerome Catholic School does not serve IEPs
but can create a Student Service Plan (SSP) if the school determines it is able to meet the needs of the student with
appropriate accommodations to the school curriculum.

                                          Parent Questionnaire

How did you learn about St. Jerome Catholic School? _____________________________________________________

____________________________________________________________________________________________________
Which activities or hobbies does your child enjoy most?

__________________________________________________________________________________________________

How do you feel that your child learns best?

__________________________________________________________________________________________________
What led you to consider St. Jerome Catholic School for your child?
____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
____________________________________________________________________________________________________
What are your goals for your child at St. Jerome Catholic School?

____________________________________________________________________________________________________

____________________________________________________________________________________________________
Teacher Recommendation Form
                               Applicants for Preschool, Pre-K, and Kindergarten
 To the parent/guardian: Please complete the following portion of this form and give it to your child’s daycare or
 preschool teacher with a stamped envelope addressed to St. Jerome Catholic School – 10815 N. 35th Avenue –
 Phoenix, AZ 85029. Your signature acknowledges your permission to share this information with our school.

 If your child has never been in a school or daycare setting, we ask parents to complete the information below to
 the best of your ability based on your experiences of working with your child.

 Name of Child:________________________________________                 Date of Birth: ______________________

 Current School: _______________________________________                Grade Level in 2018-19: _____________

 Parent/Guardian Signature: ____________________________                Date: ____________________________
 __________________________________________________________________________________________
 To the daycare or preschool teacher: This form is designed to allow St. Jerome Catholic School to learn more
 about the educational background and needs of the student whose name appears below. Your candid assessment
 is very helpful in our attempt to find school placement appropriate for the student. Thank you in advance for
 taking the time to complete this information.

 I have known this child _____ years, _____ months. He/she is enrolled in our daycare/school __________________

 days per week, _________ hours per day. This class has ________ students and ___________________ teacher(s).

                               Your evaluation is used solely for the admissions process.
                                          Area of       Age         Needs      Check if this
Skills                                    strength   appropriate     help      is a concern        Comments
Demonstrates attention span
Ability to focus in group situations
Ability to follow directions
Completes work independently
Respect for classroom rules
Transitions between activities
Responds to behavioral directions
Shows curiosity
Ability to self-start
Enthusiasm for new activities
Problem solving ability
Seeks assistance
Takes responsibility
Expresses ideas
Grasps new concepts
Uses materials appropriately
Area of         Age        Needs     Check if this
Physical Development                  strength     appropriate    help     is a concern      Comments
Fine motor skills
Gross motor skills
Speech development
(articulation)

                                      Area of         Age        Needs     Check if this
Social Emotional                      strength     appropriate    help     is a concern      Comments
Exhibits courtesy and respect
Shows empathy towards peers
Works cooperatively with peers
Demonstrates self-control
Shares well without prompting
Imagination/creativity
Demonstrates the ability to lead
Demonstrates the ability to
follow
Expresses feelings
appropriately
Shows self confidence

Family Information              Consistently     Usually    Sometimes    Rarely            Comments
Communicates openly
with the school
Participates in school
activities
Cooperates with
classroom teacher
Cooperates with
administration
Follows rules and
procedures
Please use the space below for any information that would be helpful in meeting the needs of this child.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

_________________________________________                          ____________________________________
Teacher’s Name                                                     Signature
_________________________________________                          ____________________________________
School Phone Number:                                               Email address
Upon completion, please return this form via mail, fax, or electronic message.
Mail: St. Jerome Catholic School, Attn: Bridget Martinez, 10815 N. 35th Avenue – Phoenix, AZ 85029
Fax: 602-467-4929                                                 Email: bmartinez@saintjerome.org
Teacher Recommendation Form
                                         Applicants for Grades 1 - 8
To the parent/guardian: Please complete the following portion of this form and give it to your child’s teacher
with a stamped envelope addressed to St. Jerome Catholic School. Your signature acknowledges your permission
to share this information with our school.
 Students in grades 1-5 will return one recommendation form from their classroom teacher. Applicants for grades
6-8 should submit recommendation forms from both their math and English teachers.

Name of Child:________________________________________              Date of Birth: ______________________

Current School: _______________________________________             Grade Level in 2017-18: _____________

Parent/Guardian Signature: ____________________________                    Date: ____________________________
__________________________________________________________________________________________
To the teacher: This form is designed to allow St. Jerome Catholic School to learn more about the educational
background and needs of the student whose name appears above. Your candid assessment is very helpful in our
attempt to find school placement appropriate for the student. Thank you in advance for taking the time to
complete this information.
I have known this student ________________________ years, __________________________ months.
                               Your evaluation is used solely for the admissions process.
                                                            MOST OF
ATTENDANCE AND HEALTH                                       THE TIME         SOMETIMES             RARELY
How often does this student
…attend school on a regular basis?
…arrive at school on time most days?
…appear to be in good health?

                                                                  Above                  Below
ACADEMIC SKILLS                                      Excellent   average     Average    Average         Poor
Written expression
Oral expression
Willingness to take risks
Initiatives and motivation
Participation in class
Reaction to criticism
Consideration of other's feelings
Independence
Sense of responsibility
Creativity
Study habits
Application of knowledge and skills
Self-discipline
Honesty/integrity
ATTENTION                                                           YES          UNCERTAIN                   NO
Does this student
…easily transition from one activity to another?
…continue an activity without constant attention?
…continue a task until completed or time stopped?
…usually accepts limits set by an adult?

                                                                            Most of    Some of
SOCIAL EMOTIONAL                                                 Always     the time   the time     Rarely        Never
Does this student
…willingly and cooperatively participate in groups?
…show concern for using materials appropriately?
…show leadership skills among classmates
…need redirection more often than other students?
…treat other adults and classmates with respect?
…follow directions?
…have self-control?
…display emotional maturity?

How would you describe this student? (select all that apply)

□ Competitive              □ Negative                     □ Well liked                 □ Determined
□ Motivated                □ Focused                      □ Average academically       □ Cooperative
□ Artistic                 □ Below average academically   □ Easily distracted          □ Advanced academically
□ Defiant                  □ Well organized               □ Responsible                □ Athletic
□ Enjoys school            □ Needs discipline             □ Immature                   □ Silly
□ Needs to be
challenged                 □ Mature                       □ Self directed              □ Dislikes school

 Please use the space below to elaborate on any of the sections above or to share information that would
 be helpful in meeting the needs of this child. ___________________________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________

 _________________________________________                         ____________________________________
 Teacher’s Name                                                    Signature
 _________________________________________                         ____________________________________
 School Phone Number:                                              Email address
 Upon completion, please return this form via mail, fax, or electronic message.
 Mail: St. Jerome Catholic School, Attn: Bridget Martinez, 10815 N. 35th Avenue – Phoenix, AZ 85029
 Fax: 602-467-4929                                                 Email: bmartinez@saintjerome.org
Parental Permission for Release of Student Records
I herewith give my permission for the release of information requested in the bottom portion of this form for my
(son/daughter).

________________________________________                                          _______________________
Student’s Name
                                                                                  Current Grade

________________________________________
Date

________________________________________
Signature of Parent/Guardian

Instructions: Parents, please give this signed parental permission form to your child’s current school in order for the
school to have permission to send records to St. Jerome Catholic School.

            Request for Student Report Card and Standardized Test Scores

Date: _____________________

_________________________________ is a candidate for admission to ______ grade at
          Student’s name

St. Jerome Catholic School.

Please forward the following information:

______ Report Cards for 4th quarter         _____ Standardized Test Scores (AzMerit/Dibbles/District Test)

______ Health and dental records            _____ Personal health history

____________________________________________
Principal Signature or designee (Office personnel)

Upon completion, please return this form and records via mail, fax, or electronic message.

Mail: St. Jerome Catholic School, Attn: Bridget Martinez, 10815 N. 35th Avenue – Phoenix, AZ 85029
Fax: 602-467-4929                                                 Email: bmartinez@saintjerome.org
Parish Affiliation
                                  (For Catholic Students Only)

Families of Catholic students must be registered with a parish in the Roman Catholic Diocese
of Phoenix in order to receive the Catholic tuition rate for their children. Please indicate the
parish below where your family is registered.

Student(s) Name(s)

____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

____________________________________________________
                     Parish

____________________________________________________
                     Pastor’s Name

____________________________________________________
                      City

____________________________________________________
                     Parish Phone Number

Families registered with a parish other than St. Jerome Catholic School are asked to provide a
letter from their pastor or office personnel verifying their membership. This information will
assist us and the proper pastor with the keeping of accurate records.
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