Saint John the Baptist Middle School Application Packet School Year

Saint John the Baptist Middle School Application Packet 2017-2018 School Year Thank you for your interest in Saint John the Baptist Middle School. The attached application and accompanying items must be received by Wednesday, February 15, 2017 for your child to be considered for current openings. Application packets will be accepted after February 15 for openings that may occur between February 15 and the beginning of the 2018-2019 school year. Students from previous waiting lists will not be considered for enrollment; parents must resubmit an application packet. All applicants are required to take an entrance exam, which will be given on Wednesday, February 22, 2017 at 2:00pm. Admittance of students will be based after review of your son/daughter s application packet and entrance exam, and according to the following priorities, as deemed by the Diocese of Salt Lake City, as space is available and at the discretion of the school s administration: 1. Children presently enrolled. 2. Siblings of students enrolled at Saint John the Baptist Middle School. 3. Children of active members of Catholic parishes without a school and/or siblings of students enrolled at Saint John the Baptist Elementary School and/or Juan Diego Catholic High School. 4. Children of Catholic parishes with a school. 5. Children from non-catholic families. Please note that students with an incomplete application and/or those who have not completed the entrance exam will not be considered for enrollment. The following items must be submitted for an application to be considered complete: Copy of state issued birth certificate Copy of baptismal certificate (if applicable) Copy of immunization records Copy of most recent report card Copy of most recent standardized test scores $35 application fee Please call Patrick Reeder (Principal) or Jean Synowicki (Assistant Principal) at (801) 984-7614 with questions and/or to schedule a tour of the Skaggs Catholic Center. Saint John the Baptist Middle School develops the whole student by providing a quality Catholic education in a community environment. www.sjb-middle.org

Student Name: Date of Application Grade Entering 2017-2018 School Year Saint John the Baptist Middle School Skaggs Catholic Center, LLC 2017-2018 School Year Student Application INSTRUCTIONS: 1. Parent or guardian must complete and sign this form. A $35.00 nonrefundable application fee must accompany this application along with the following items: 1) copy of state issued birth certificate, 2) copy of baptism certificate (if applicable), 3) copy of most recent report card, 4) copy of immunization records, and 5) copy of most recent standardized test scores. Incomplete applications will not be considered. 2. Please submit a separate application and fee for each child seeking admission. Send completed applications to: Saint John the Baptist Middle School Attention: Admissions 300 East 11800 South Draper, UT 84020 3. Upon acceptance for the 2017-2018 school year, the following items must be submitted before the student is considered enrolled: Sate of Utah - Unified Health Appraisal Form 2017-2018 Tuition Contract FACTS Tuition Management Agreement This form must be completed with bank and tuition payment method (annual, monthly, etc.) information. Request for Records This form must be completed in order for student records to be forwarded to Saint John the Baptist Middle School from the school last attended. We, the community of Saint John the Baptist Middle School, are commissioned by the Church and delegated by the parents to teach the children entrusted to our care. We are committed to fostering our Catholic identity according to the four Marks of the Church: One in community, Holy through the sacraments, Catholic in the universality of the church, and Apostolic in being witnesses to the good news of Jesus Christ. Our qualified and dedicated faculty and staff provide thorough instruction with the expectation of academic excellence. We recognize and affirm the various needs of learners. Our curriculum incorporates faith-related values, academic standards, and teaches skills necessary for lifelong learning. We focus on educating the whole child: intellectually, socially, physically, emotionally, and spiritually. As a unique cradle-to-college community, we develop compassion, love, and respect while emphasizing service to others. www.sjb-middle.org

STUDENT INFORMATION EMERGENCY INFORMATION Student s Legal Name (last, first, middle) Street Address Emergency Contact/Authorized Pickup: (Individuals listed below will be called if parent/guardian cannot be reached and are the only individuals other than parent/guardian who may check student out during the school day) City, State, Zip Home Phone Number Cell Phone Name Home Phone Date of Birth (month/day/year) Place of Birth (city/state/country) Cell Phone Name Home Phone Male Female School Currently Attending Cell Phone Name Home Phone Public School District Student Lives In Student s Religion Cell Phone Name Home Phone Name of Parish/Church Has student ever attended a Catholic School within the Salt Lake Diocese? Yes No If yes please list school, year, and reason for withdrawal: Special Medical Considerations Is student baptized? Yes No Has student received First Communion? Yes No Allergies Student Ethnicity and Race Please select both Ethnicity and Student Race (Used for reporting purposes only) Student Ethnicity: Hispanic Student Race: Native American Asian Black/African American Native Hawaiian/Pacific Islander White Multiple Races Unknown Non-Hispanic (As defined by the U.S. Census Bureau) In case of an emergency, I authorize Saint John the Baptist Middle School/Skaggs Catholic Center to call an ambulance, paramedics, or fire department and to follow their instructions. The school/center does not assume responsibility in the above emergency procedures used and does not assume payment for measures taken. Parent Signature/Date

FATHER/GUARDIAN MOTHER/GUARDIAN Last Name First Name Middle Father Step-Father Guardian Other Last Name First Name Maiden Mother Step-Mother Guardian Other Spouse s Name (if different from Mother listed) Spouse s Name (if different from Father listed) Address & Phone (if different than student) Address City/State/Zip Address & Phone (if different than student) Address City/State/Zip Home Phone Cell Phone Home Phone Cell Phone Occupation Occupation Employer Employer Work Phone Work Phone Email Address (Please print) Email Address (Please print) Religion Parish Religion Parish Student is living with: Both Mother & Father FAMILY STATUS Religion Parents are divorced/separated. Student lives with: Custody Restrictions: Yes (Court records must be submitted) Second Parent/Guardian Mailing Information: Name: All student information to be sent to second parent/guardian?!! YES!! NO Address: Home Phone: Cell Phone: Email Address: SIBLINGS Applying to Name (Last, First, Middle): Grade Current School: 2017-2018: SJB/JDCHS:!!!!!!!!

Your candid responses will help Saint John the Baptist Middle School learn more about your child. Please describe your child s academic strengths and weaknesses: Please describe your child s personal strengths and weaknesses: Did he/she skip any grades? Repeat any grades? Has your child undergone any evaluative testing either through the school or outside the school? Yes No If Yes, please attach a copy of the report of your child s most recent testing. Date of testing: Reason for testing: Does your child have an IEP? Yes No If so, please attach a copy of it to this application. Does your student have other diagnosed health and/or leaning impairments? Yes No If yes, please explain: Is your child receiving the Carson Smith Scholarship? Yes No Is a language other than English spoken in your home? Yes No If Yes, what language? Is the applicant bilingual? How did you hear about Saint John the Baptist Middle School? Why are you interested in Saint John the Baptist Middle School for your child? Has the applicant ever been dismissed from school for any reason? Suspended? Asked to withdraw? If Yes, please explain:

Additional information regarding the applicant that may be helpful in determining his/her acceptance: Recommendations: Please complete the following for the individuals who will be completing the two recommendation forms. Saint John the Baptist Middle School requires two recommendations from individuals who have worked closely with the applicant in the past year. (At least one recommendation must come from a current teacher.) Name Position/Title School City/State Name Position/Title School City/State I will be applying for financial aid at https://online.factsmgt.com/signin/3g31v Yes (New families should apply within 21 days of acceptance to SJBMS) No Signature of Parent/Guardian Relationship to Applicant Date (Parent/legal guardian signature needed to proceed with application process) OFFICE USE ONLY Application Fee Cash Check # Copy of state issued birth certificate Copy of baptismal certificate (if applicable) Copy of most recent report card Copy of most recent standardized test scores Date application packet complete Application reviewed by:

Saint John the Baptist Middle School Student Questionnaire To be completed by the applicant in his/her own handwriting without assistance. Print Full Name Current Grade: Nickname or name usually called: What class do you enjoy most? Why? What class is your least favorite? Why? Describe an academic accomplishment of which you are very proud: Describe your involvement in school activities and any leadership roles you may have held in these areas: What newspapers and/or magazines do you enjoy reading? Why do you choose these publications to read? If you could recommend just one book for all other students in your grade to read, which book would you choose and why? (continued on back)

In what way do you most enjoy spending your summer? Have you attended any day camps or sports clinics, or volunteered in any summer programs? Describe your creative activities such as art, dance, music or theatre (include honors, prizes and positions of leadership). Describe your athletic activities. What teams and athletic clubs are you involved with outside of school? (include honors, prizes and positions of leadership) What plans do you have for your future beyond high school? Tell us a verse from a favorite song that has a significant meaning to you. Why did you choose this song verse and how has it affected you. Additional interests or information about yourself that you would like to share.

Saint John the Baptist Middle School Confidential Recommendation Name of Student: First Middle Last Student s Current Grade: Current Academic Year: To the teacher: The student referenced above is applying to Saint John the Baptist Middle School. Your assessment and comments on this student s scholastic achievement and character is appreciated. Thank you for your assistance. Please rate the student on the following criteria. Intellectual curiosity Academic ability Academic potential Academic performance Ability to follow instructions Ability to work independently Involvement in class activities Oral communication Written communication Outstanding Above Average Average Below Average Unable to rate Motivation Organization Leadership Reliability Self-esteem Character Emotional maturity Relationship with peers (continued on back)

Please list the student s special talents and/or strengths: Please list the student s areas of weaknesses or areas in need of further development: How does this student contribute to the class and/or the school environment? Please add any additional comments or concerns: Signature: Name (Please print.): Title or Position: Thank you for taking time to respond. Your comments are appreciated. Please return to: Saint John the Baptist Middle School Attention: Admissions 300 East 11800 South Draper, Utah 84020