DCC K-12 Application | DuBois Central Catholic School

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About Us
Academics
Admissions
Athletics
Alumni
Students
Parents
Giving
Donate
Covid-19
- DCC Back to School Plan
- Catholic Schools Office Recommendations

–

DCC K-12 Application

Student's Name *

First

Middle

Last

Gender

Male
Female

Child's Eye Color

Child's Hair Color

Child's Height

Child's Weight

Is there any significsnt pertinent history (school, developmental, medical, or psychological) which we should know about the child?

If so, please describe

Grade Student Would Be Entering

Date of Birth (Ex. 01/23/2022)

Birth Certificate Number

Place of Birth

Social Security Number

Religion

Address

City

State

Zip Code

Phone

Student lives with

Both Parents
Mother
Father
Other

If Child does not live with a parent, who is legal guardian? (must have court papers)

Baptism - (Date, Church, Location, Certificate Verified)

First Eucharist- (Date, Church, Location, Certificate Verified)

Public School District in which Student Resides

School Last Attended (Name, Address, City, State, Zip Code)

Which Grades Did the Student Attend?

List All Previous Schools, including Grades and Years

Did Child ever Repeat a Grade?

No
Yes

Does Child Have Difficulty Learning?

No
Yes

Does Child Have Any Behavioral Problems?

No
Yes

List all Auxiliary Services the Child Receives (Act 89, Title 1, Speech Therapy)

Select All Special Programs Child Has Attended (Use CTRL CLICK to Select More than One)

Has Child Previously been offered an Individualized Education Program (IEP)?

Yes
No

If Child had an IEP, List Date and Grade

Did the Child have a Chapter 15-504 Plan?

Yes
No

If the Child had a Chapter 15-504 Plan, List Dates and Grades

What language does the child speak?

What language is spoken in the home?

Father's Name

First

Last

Father's Address

Father's City, State and Zip Code

Father's Phone Number

Father's Email

Father's Employer

Father's Work Address

Father's Work Phone

Father is a Contributing Parishioner of What Church?

Mother's Name

First

Last

Mother's Address

Mother's City, State, and Zip Code

Mother's Phone Number

Mother's Email Address

Mother's Employer

Mother's Work Address

Mother's Work Phone

Mother is a Contributing Parishioner of What Church?

Name of Stepparent or Other Guardian

First

Last

Address of Stepparent or Other Guardian

Stepparent's or Other Guardian's City, State, and Zip Code

Stepparent's or Other Guardian's Phone Number

Stepparent's or Other Guardian's Email Address

Stepparent's or Other Cuardian's Employer

Stepparent's or Other Guardian's Work Address

Stepparent's or Other Guardian's Work Phone

Stepparent or Other Guardian is a Contributing Parishioner of What Church?

List Names of All Other Children Living in the Home with Relationship to the Applicant and their Birthdate

Ex. Charlie Smith, Brother, 04/22/2006

Comment or Message

If you do not hear back from the school in two business days, please call 814-371-3060 ext. 607.

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:
Maria Aucker – maucker@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)

Search for:

DuBois Central Catholic School Grades PK - 12
P.O. Box 567
200 Central Christian Road
DuBois, PA 15801
814-371-3060