Joliet Catholic Academy

Transfer Student Application for Admission

Directions: Complete, in full, the online application and submit unofficial transcripts from the student's current school to JCA's Associate Principal

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Qty

Description

Amount

Total

Application Fee

$30.00

Total: $30.00

Student Information

Student First Name: *

Student Last Name: *

Gender: *

Home Address:

City:

State:

Zip Code:

Home Phone: *

Student Email:

Student's Cell Phone: *

Date of Birth: *

Place of Birth: *

(city, state, county)

Name and Phone: *

Please list the name and phone number of a person other than an immediate family member that knows your address and phone number:

How did you hear about JCA? *

Other:

Electronic Signature

As a parent/legal guardian of the above named child, my permission is given to release to Joliet Catholic Academy my student’s school records, including, but not limited to confidential academic, special education and disciplinary information, and records concerning my child. I also grant permission for Joliet Catholic Academy to dialogue openly with appropriate parties at my child’s current school about matters related to admissions and placement.

I understand JCA will not accept a transfer student if he/she is suspended or expelled from his/her current high school.

Parent/Guardian Name: *

Date of Application: *

Student’s Name: *

As the student's parent/guardian, I certify that the information provided on this application is accurate and true. I understand that falsified or incomplete information may result in the denial of admission and/or termination of enrollment at Joliet Catholic Academy.

Educational Status

Grade you plan on entering into when you become a student: *

Term you are interested in enrolling: *

Term Year: *

Name of Current High School: *

Enrollment Status:

Other High Schools

List the names of any additional high schools you have attended.

Have you ever been under expulsion or suspension? *

Name of grammar school/ middle school/ junior high you graduated from:

Special Education Information

Do you have a current IEP, ISP or 504 Plan? *

If yes, from what district?

Accommodations/Services

Check the accommodations/services below that you are currently receiving or have been recommended to receive:

Title I Reading

Title I Math

Learning Disabilities

Behavior Disorders

Speech Pathology

Specialized Instruction

Other (please specify):

Religious Information

What is your religious affiliation? *

Other (please list):

Name of your parish/church/synagogue:

Street Address:

Address 2:

City:

State:

Zip Code:

Ethnic Background

Check the background with which you most closely identify:

Caucasian

Black (not of Hispanic origin)

Hispanic

American Indian or Alaskan Native

Asian or Pacific Islander

Family Information

Student lives with: *

Father/Stepfather/Guardian Information

Please choose: *

Please choose:

First Name:

Last Name:

Living

Deceased

Religion:

Occupation:

Company Name:

Company Phone:

E-mail Address:

Cell Phone:

DLS/JCHS/JCA Alumus?

Mother/Stepmother/Guardian Information

Please choose: *

Please choose:

First Name:

Last Name:

Living

Deceased

Answer:

Religion

Occupation:

Company Name:

Company Phone:

E-mail Address:

Cell Phone:

SFA/JCA Alumna?

Additional Family Information

List the names of any brothers or sisters currently attending Joliet Catholic Academy

Name:

Current Year:

List the names of any younger brothers or sisters

Name:

School Attending:

Current Grade:

List the names of other family members who are alumni of SFA, DLS, JCHS, or JCA

Name:

Relationship:

Class Year:

Transfer Student Questionnaire

Please answer the following questions honestly and completely. The purpose of the following questions is to assist Joliet Catholic Academy in gathering a complete profile of the applicant. This information will be used to assess the student’s eligibility. Missing or incorrect items will delay the application process.

Introductory Questions

What is your reason for requesting to transfer to Joliet Catholic Academy?

Do you know any students who are currently attending JCA?

If yes, provide no more than three names of students you know:

Academic History

Has this student ever failed a high school course?

If yes, please list the course(s):

If yes, please list the course(s) and what, if any, make up credit was completed as well as where it was completed.

Has this student missed more than 10 days of school in one academic year?

If yes, please list the reason(s) for the absences:

Has this student ever been on academic probation?

If yes, for how many semesters?

Has this student ever received or been recommended to receive academic services?

(i.e. Sylvan Learning Center, Learning Resource Tutoring)

If yes, please list services:

Behavior History

Has this student ever been placed on disciplinary probation?

If yes, list the school where the student was placed on disciplinary probation & circumstances:

Has this student ever been suspended from school?

If yes, list the school where the student was suspended and explain the circumstances:

Has the student ever been expelled or dismissed from school or not permitted to return to school?

If yes, list the school where the student was expelled, dismissed from, or not permitted to return:

Has this student ever been accused of or convicted of a crime?

If yes, please explain:

Personal History

Was this student ever recommended for drug and/or alcohol evaluation and/or treatment?

If yes, please explain:

Is this student on medication?

If yes, please indicate what the medication is for:

Has this student received, or been recommended to receive, mental health counseling?

If yes, please explain:

Extracurricular History

List any clubs and/or organizations, either in our out of school, in which you have participated:

List any volunteer activities that you have been involved in through your parish and/or community:

List any high school clubs and/or teams that you have participated in with year of participation:

(i.e. Football Manager - Freshman; Math Team - Sophomore)

List any school, parish, community, and/or athletic awards or recognitions that you have received:

Parent/Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

Email: *

A receipt will be emailed to this address.

Comments:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *