DCC K-12 Student Application

• Child's Name, Last/First/Middle *

• Child Lives with: (Please Check) *

  Both Parents   Mother   Father   Other

• Legal Custody with (Must have court papers)

• Address- House No., Street, Apt.No., Lot No., City, State, Zip Code *

• Parent/ Guardian's Phone Number - Home, Cell, Work *

• Parent/Guardian's Email *

• Gender -Select one *

  Male   Female

• Child's Date of Birth *

• Birth Certificate Number *

• Place of Birth, City/State *

• Religion

• Baptism: Date, Church, Location, Certification Verified

• First Eucharist: Date, Church, Location, Certification Verified

• Public School District of Residence *

• Grade Child Would Be Entering *

  K   1st   2nd   3rd   4th   5th   6th   7th   8th   9th   10th   11th   12th

• School last attended: Name, Address, City, State, Zip *

• School last attended: Grade________to Grade________ *

• What influenced your decision to enroll this child at DCC - Please check only the most important one.

  personal contact with a Central student or family or staff memberthe DCC websitethe faith-based education offeredquality instruction -programs-activitiesattending school eventsthe local mediaCardinal Chatter or Social Mediachurch affiliationfamily traditionschool environmentOther - Please state below

• Other from the above question

• Did child ever repeat a grade? *

  No   Yes

• Has Your Child Ever Been Homeschooled?

  YesNo

• If so, for how many years?

• Has child previously been offered an Individual Education Program (IEP)? *

  No   Yes

• If yes, list date/grade

• What language(s) does the child speak? *

• What language(s) is spoken in the home? *

• Father: First/Last Name, Home Address, Home Phone, Employer's Name, Work Address, Work Phone, and Contributing Parishioner Of:

• Mother: First/Last Name, Home Address, Home Phone, Employer's Name, Work Address, Work Phone, and Contributing Parishioner Of:

• Step-Parent: First/Last Name, Home Address, Home Phone, Employer's Name, Work Address, Work Phone, and Contributing Parishioner Of:

• Step-Parent: First/Last Name, Home Address, Home Phone, Employer's Name, Work Address, Work Phone, and Contributing Parishioner Of:

• Other: First/Last Name, Home Address, Home Phone, Employer's Name, Work Address, Work Phone, and Contributing Parishioner Of:

• List Any School Activities in which the student has been or is now involved.

• List Any Outside of School Activities in which the student has been or is now involved.

 

A non-refundable $50 application fee is required.

If you do not hear back from the school in two business days, please call 814-371-3060.

 

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Title IX Clause:  While reserving the right to make religious exceptions as provided by law and in accord with Catholic religious belief, the Catholic schools within the Diocese of Erie do not discriminate on the basis of sex.  This includes being excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity on the basis of sex.

Title IX Coordinator:
Ms. Tia Snyder: tsnyder@duboiscatholic.com
DuBois Central Catholic
PO Box 567
DuBois, PA  15801
814-371-3060 ext. 635

For additional information visit the Catholic Schools Office website:
The Roman Catholic Diocese of Erie, Pa. (eriercd.org)