Apply to Badin! - Stephen T. Badin High School

Stephen T. Badin High School Application for Admission1. Student Information:—Please Print Clearly—Legal Name_____________________________________________________________________________________________ Preferred Name_______________________Last First MiddleStreet Address______________________________________________________ Apt. ___________City ________________________________________ State_____________ Zip_________________Ethnic Code ___________ (Choose One: A-Asian/Pac. Island; B-African American; H-Hispanic; I-American Indian/Alaskan; M-Multi-Racial; W-Caucasian)Home Phone_______________________________________________Email Address _____________________________________________________________________Birthplace (City, State, Country) _______________________________________________________________________________________Birthdate __________________________ Gender ____________ T-Shirt size Adult S Adult M Adult L Adult XL Adult XXLCurrent Grade___________ Current School ____________________________________________________________ School Phone _______________________________Public School District _____________________________________________ Public High School to Which You are Assigned ________________________________________Religion_____________________________________ Parish/Church Affiliation _________________________________________________Applicant lives with: Both Parents Mother Father Stepparent Other __________________________________Is there a court order regarding custody of this student? YES NO (If a court order exists, Badin High School must have a copy of said order)Who has legal custody of this student?______________________________________________________________________________2. Parent/Guardian Information:Father _______________________________________________________________________________________________________________LastFirst__________________________________________________________________________________________________________________________________________Street (If different than student) City State Zip__________________________________________________________________________________________________________________________________________Occupation Employer Business Phone__________________________________________________________________________________________________________________________________________Cell PhoneEmailMother ______________________________________________________________________________________________________________LastFirst_________________________________________________________________________________________________________________________________________Street (If different than student) City State Zip_________________________________________________________________________________________________________________________________________Occupation Employer Business Phone_____________________________________________________________________________________________________________________Cell PhoneEmailAdditional Parental or Guardian Information:Name____________________________________________________________________________________________________________________________________Last First Relationship_________________________________________________________________________________________________________________________________________Street (If different than student) City State Zip_________________________________________________________________________________________________________________________________________Occupation Employer Business Phone_________________________________________________________________________________________________________________________________________Cell PhoneEmailName____________________________________________________________________________________________________________________________________Last First Relationship________________________________________________________________________________________________________________________________________Street (If different than student) City State Zip________________________________________________________________________________________________________________________________________Occupation Employer Business Phone________________________________________________________________________________________________________________________________________Cell PhoneEmail

3. Student’s Academic History: Please list the school(s) most recently attended by this student.Current________________________________________________________________________________________________________________________________________School City Grades Attended Dates EnrolledPrevious_______________________________________________________________________________________________________________________________________School City Grades Attended Dates EnrolledGraduated Elementary School Moved Academics Expulsion/Suspension Other ___________________________4. Please List All Siblings Living in Student’s Home:_____________________________________________________________________________________________________________________________________________Name Date of Birth Current School Grade Gender_____________________________________________________________________________________________________________________________________________Name Date of Birth Current School Grade Gender_____________________________________________________________________________________________________________________________________________Name Date of Birth Current School Grade Gender_____________________________________________________________________________________________________________________________________________Name Date of Birth Current School Grade Gender_____________________________________________________________________________________________________________________________________________Name Date of Birth Current School Grade Gender5. Badin/Hamilton Catholic/Notre Dame Family—Siblings, Parents, Grandparents:_________________________________________________________________________________________________________________________________________Name Relationship Grad Year_________________________________________________________________________________________________________________________________________Name Relationship Grad Year_________________________________________________________________________________________________________________________________________Name Relationship Grad Year_________________________________________________________________________________________________________________________________________Name Relationship Grad Year_________________________________________________________________________________________________________________________________________Name Relationship Grad Year6. Student Essay:Short answer: Students, please complete this in your own words:Why would you like to attend Stephen T. Badin High School?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. Badin High School Student Educational History:The Guidance Department at Badin High School requires that all students have a completed Educational History form in their guidance file.The information that you share will facilitate our efforts in supporting your child in his/her pursuit of academic success at Badin.Student’s Name ______________________________________________________________________________ Date of Birth _______________________________________________Does your child have a current Individualized Education Plan (IEP)? YES NO Does your child have a current Individualized Service Plan (ISP)? YES NO Does your child have a current 504/Intervention Plan? YES NO IF YES TO ANY OF THESE, PLEASE COMPLETE THIS SECTION AND ATTACH COPIES OF THE DOCUMENTS. INTERVIEWS WITH BADIN’S GUIDANCEDEPARTMENT MAY BE REQUIRED BEFORE ADMISSION IS GRANTED.IF NO TO ANY OF THESE, PLEASE SKIP TO PAGE 4.Please check the area(s) for which your child may have had individualized testing.Evaluation Team Report When? __________________ Gifted/Talented When? _________________Psychological Evaluation When? __________________ ADD/ADHD When? _________________Educational Evaluation When? __________________ Other When? _________________Speech/Language EvaluationWhen? __________________PLEASE ATTACH COPIES OF THE MOST RECENT EVALUATION AND RESULTS.Please check the area(s) which apply to your child.Regular Classroom Education Reading Support When? ___________________Accelerated Classes In what area(s)? ____________________ Tutoring Support Which subjects? _____________Gifted Education In what area(s)? ____________________ Speech/Language Therapy When? ____________Summer Gifted/Talented/Enrichment In what area(s)? ____________________ OT/PT ServicesSpecial Education Services Resource Rm. _____________ Tutoring_____________ Auditory or Visual TrainingFull disclosure of your child’s educational history is crucial to both the admissions process and registration for classes. You must provide Badin with allrelevant documents. If you have any other information regarding your child’s educational strengths/needs, learning styles, and/or other areas of concern,please indicate this on a separate sheet of paper and return with this form.8. Authorization of Release of Accommodation Records:I, _____________________________________________, do hereby give my permission for the school records, including speech, psychological, IEP,parent name504 Plans, or Intervention Plans for _____________________________________________ to be released to:student nameBadin High SchoolAttn: Academic Dean571 New London RoadHamilton, OH 45013By signing this release of evaluation/intervention records, I relieve the school, which the above named student was attending, of the responsibility ofnotifying me that the records are being transferred. This authorizes transfer of all school records as defined by PL 93-380 and any amendments thereto.Parent/Guardian Signature___________________________________________________________________ Date __________________________

9. Application Verification:I affirm that the information contained in this application is true and accurate. I understand that misrepresentation, falsification or omission of factson this application may result in refusal of admission and/or prompt withdrawal of any previous offer of admission._____________________________________________________________________ _______________________________________________________________________Parent/Guardian Signature Date Parent/Guardian Signature Date_____________________________________________________________________Applicant SignatureDateAPPLICATION CHECKLISTThank you for your interest in Stephen T. Badin High School. Following is a checklist to make the Badin High Schoolapplication process as easy as possible to navigate. Register to take the High School Placement Test at Badin High School by calling 513.863.3993.Take the High School Placement Test on Saturday, November 17, 2012. The fee is $30. Not taking the HSPT atBadin? Remember to have your scores sent to Badin to remain eligible for HSPT scholarships.Complete this Application for Admission, as well as a Request for Release or Transfer of School Records formavailable on the Badin Admissions website at www.badinhs.org, or by calling the Admissions Office at 513.863.3993,ext. 120. You may mail the completed forms or bring them with you on Registration Night.Mailing address: Badin High School Contact: Dirk Q. Allen, Admissions Director571 New London Road 513.863.3993, ext. 120Hamilton, OH 45013dallen@badinhs.org Enrollment materials and High School Placement Test Scholarship Award letters will be mailed on January 4, 2013.Attend Information and Registration Night on January 24, 2013 to finalize your registration and secure courseselections. Your non-refundable $300 registration fee is due at this time. The registration fee is deducted from yourtuition.Should you choose to apply for financial assistance, tuition assistance forms are available in January and can beobtained online at badinhs.org or by calling the Badin Finance Office at 513.863.3993, ext. 117. Deadline to submit Tuition Assistance Forms is March 1, 2013.