Application for Admission 2021-2022 School Year - Admissions Office Send applications to: Cristo Rey ...
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Application for Admission
2021-2022 School Year
Send applications to:
Admissions Office
Cristo Rey Columbus High School
400 East Town Street
Columbus, Ohio 43215
Phone: (614) 223-9261 x 008
Admissions@CristoReyColumbus.org
Cristo Rey Columbus High School
Admission for 2021-2022 School Year
Early Admission Deadline………………..………Tuesday, November 24, 2020*
* Applications will be accepted after November 24 until we have filled all available seats. To have the best
chance at being accepted we encourage applying for early admission.
Part 1- Application
In order for your application to be processed, we must receive the following items.
☐ Application for Admission (this packet)
☐ Proof of Income (see Section E of application)
☐ The following information from your student’s current school. Turn in the Request for
Records/Teacher Recommendation packet to your school office:
● Completed Recommendation Form from English Teacher
● Completed Recommendation Form from Math Teacher
● Completed Recommendation Form from School Leader
● Copy of report cards, discipline records, and attendance records from current and
previous grades
● Copy of standardized test scores from current and previous grades
● IEP/ISP records, if applicable
Part 2- Interview
Applicants who complete their applications may move into the second phase of the admissions process.
Applicants who have the potential to meet the criteria to be a Cristo Rey Columbus student will be invited,
along with a parent/guardian, to interview with the Director of Admissions or other school representative.
__________________
For Accepted Students only
Part 3- Registration
Students will receive notification of admission to Cristo Rey Columbus High School via mail. Students who
are accepted and plan to attend Cristo Rey Columbus must register to secure their placement in the class.APPLICATION INSTRUCTIONS OFFICE USE ONLY
● Please type or print clearly. Date Received _________
● Use blue or black ink.
Staff Receiving _________
● Fill in all blanks provided.
SECTION A: STUDENT’S PERSONAL DATA
Full Name (as on Birth Certificate):
Last First Middle Initial
Current School: Grade: __________
Birth Date: / / Religion (optional):
Month Day Year Church name (optional): ________________
Please mark racial and/or ethnic identity (optional)
☐ Asian ☐ Black or African American ☐ Caribbean Islander ☐ Hispanic or Latino
☐ Multiracial ☐ White ☐ Other _______________________________
Home Address:
Address Apt. City State Zip
Home Phone: - - Birth Place:
Gender : ☐ Male ☐ Female Currently receiving Ed Choice Scholarship? ☐ Yes ☐ No
Language spoken at home: Other Languages Spoken:
Student’s Cell Phone (optional): - -
Student Lives With: (Check all that apply.)
☐ Mother only ☐ Father only ☐ 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 CustodySECTION 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: _____________________________________________________________________________
Explain why Cristo Rey Columbus is a good fit for you, and why you are a good fit for Cristo Rey:
__________________________________________________________________________________________
Do you have any family members who have attended Cristo Rey (current or previous)? 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
☐ Word of mouth (family, friend, etc.) ☐ Social Media
What school district do you live in?
______
What public high school would you be assigned to?
______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
Highest Level of Education: ☐ some HS ☐ HS diploma ☐ some college ☐ Associate’s (2 year degree)
☐ Bachelor’s (4 year degree) ☐ Master’s or higher
Home Address:
Address Apt. City State Zip
Home Phone: ________-________-_________ Work Phone: _______-________-____________
Cell Phone: ________-________-_________ _ Email: ____________
Employer: _ Occupation: _____________________________
Please check the best way to contact you.
______ Work Phone ______ Home Phone ______ Cell Phone ______ Text Message ______ Email
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
Highest Level of Education: ☐ some HS ☐ HS diploma ☐ some college ☐ Associate’s (2 year degree)
☐ Bachelor’s (4 year degree) ☐ Master’s or higher
Home Address:
Address Apt. City State Zip
Home Phone: ________-________-_________ Work Phone: _______-________-____________
Cell Phone: ________-________-_________ _ Email: ____________
Employer: _ Occupation: _____________________________
Please check the best way to contact you.
______ Work Phone ______ Home Phone ______ Cell Phone ______ Text Message ______ EmailSECTION 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 now or ever been enrolled in gifted 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?SECTION E: INCOME VERIFICATION (to be completed by parent or guardian)
All families must complete the income verification form below and submit proof of income (see below) with
their application. Please list all members of your household along with their individual income. If a family
member does not receive income enter “none”. If needed, please use an additional sheet of paper or use the back
of this page.
First and Last Name Relationship Source of Income (check all that Gross How Often
to Student apply) Amount Received
Before Taxes
Proof of Income:
1. For all household members filing taxes:
a) Provide most recent tax return (1040 forms).
2. If adult household members do not file taxes OR have additional cash income:
a) Provide signed letter from employer indicating income, OR
b) Bank statements (2 consecutive months), OR
c) Paystubs (2 consecutive payments)
3. Provide proof of all other forms of income including Social Security, TANF, unemployment, Child
Support, Alimony, Worker’s Compensation, or other.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 approximately every four weeks of the school year, excluding holidays and days
when school is closed. I understand the student’s earnings will be used 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 business 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.
Cristo Rey Columbus High School does not discriminate on the basis of race, color, national or ethnic origin.
My signature indicates my permission for the release of my child’s school records to Cristo Rey Columbus High School.
Student Signature Date
Parent/Guardian Signature Date
NOTA IMPORTANTE PARA ESTUDIANTES, LOS PADRES Y REPRESENTANTES:
Por favor revise cuidadosamente y firme a continuación.
Comprendo que la Escuela Secundaria Cristo Rey Columbus es una escuela católica con un riguroso programa académico que
posee un código de asistencia obligatoria, vestimenta y conducta. La marca que diferencia esta escuela es su Programa
Profesional de Trabajo-Estudio en el cual los estudiantes trabajan un día entero cada semana y un quinto día cada cuatro
semanas del año escolar aproximadamente, con excepción de los días feriados y los días en que no haya clase. Comprendo que
lo que gane el estudiante cubrirá una porción 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 Columbus está sujeta al recibimiento de un certificado académico oficial que
demuestre que el aspirante completó satisfactoriamente el grado actual y a la conclusión satisfactoria de nuestro programa de
entrenamiento profesional de verano obligatorio. Las decisiones de admisión e inscripción se realizan exclusivamente a
discreción de la administración de Cristo Rey Columbus. Certifico que la información proporcionada en esta aplicación es
completa y precisa. Y, además, afirmo que si proveo información falsa, la admisión de mi hijo(a) podría ser perjudicada.
Cristo Rey Columbus High School no discrimina por motivo de raza, color, nacionalidad u origen étnico.
Mi firma indica mi autorización para emitir los archivos de mi hijo(a) a la Escuela Secundaria Cristo Rey Columbus.
Firma del Estudiante Fecha
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