St. Mary Magdalen Catholic School Financial Responsibility Form

St. Mary Magdalen Catholic School
ad vitam paramus
ADMISSIONS CHECKLIST
2013 - 2014
Please complete an application packet listing each child applying for admission
to St. Mary Magdalen Catholic School. A $25.00 nonrefundable fee must be
included. Please print or type clearly.
Please submit the following documents with your registration packet:

Application for Admission (Parent Information)

Application for Admission (Student Information)

Financial Responsibility Form

GAP (Giving Annually Program)

Kindergarten Developmental Readiness Evaluation (Incoming Kindergarten)

Request for Information Prior to Acceptance (Incoming Grades 1 – 8)

Birth Certificate (photocopy)

Baptismal Certificate (photocopy)

Social Security Card (photocopy)

Family Photo
ACADEMIC RECORDS
 Your child’s latest report card (Grades 1 - 8)
 Standardized test scores from tests which your child has taken (Grades 1 - 8)
HEALTH FORMS
Each student must submit an original DH680 Florida Certification of Immunization and
an original DH3040 State of Florida School Entry Health Exam
869 MAITLAND AVENUE ∙ ALTAMONTE SPRINGS, FLORIDA 32701
PHONE 407.339.7301 ∙ FAX 407.339.9556
www.smmschool.org
St. Mary Magdalen Catholic School
869 Maitland Avenue, Altamonte Springs, Florida 32701
Telephone: 407/339-7301
APPLICATION FOR ADMISSION
PARENT INFORMATION
2013 - 2014 School Year
Parent Information – Please print.
FATHER
MOTHER
_______________________________________________ _______________________________________________
Legal Name as Shown on Driver’s License (Last, First,
Legal Name as Shown on Driver’s License (Last, First,
Middle)
Maiden)
Address, City, State Zip Code
Social Security Number (SSN)
Driver’s License Number
Home Telephone
Work Telephone
Cell Phone
Religion
Date of Birth
Place of Birth
Occupation
Employer
U. S. Citizen
Alumnus of St. Mary Magdalen
Catholic School?
Date graduated if yes _______________
Date graduated if yes _____________
Marital Status
Parish Name: ____________________________________________________________
Family Email Address: ___________________________________________________________
Please list all children in the family from oldest to youngest. Include non-school age children.
Last Name
First Name
Age
Present Grade
School
Parent Signature ____________________________________________Date Application Submitted _________________
For office use only:
Application Fee Paid Application
Registration Fee Paid
Complete Incomplete Gap Donation
Material Fee Paid Check # __________________
Cash ____________________
Nationally Recognized Blue Ribbon School 2006
St. Mary Magdalen Catholic School
869 Maitland Avenue, Altamonte Springs, Florida 32701
Telephone: 407/339-7301
APPLICATION FOR ADMISSION
STUDENT INFORMATION
2013 - 2014 School Year
Student Information – Please print.
Student Last Name
Present
Grade
First Name
Student lives with
→
Name:
Address
Street Address:
Grade Applying For
K
1
2
3
4
5
6
7
8
Relationship:
City:
State:
Zip Code:
Date of Birth
Gender
Male
Female
U.S. Citizen
Yes
No
Social Security Number
Ethnic Group
(Check one box)
White
Black
Hispanic
Native Hawaii / Pacific Island
Asian
Multi-Racial
Native American
Religion
Baptismal Date
Catholic
Other
Church /
Address
First Communion Date
Church /
Address
Reconciliation Date
Church / Address
Confirmation Date
Church / Address
Please list all schools this student has attended, beginning with the most current school.
Name of School
Address
Medical Information
1. Does your child take any medication on a regular basis?
Medication
Grades Attended
Yes
No
Dosage
Reason for Leaving
If yes, please list medication(s), dosage, times given.
Times Given
2. Does your child have any health problems?
(For example, allergies to foods, medicine or bee stings; diabetes, asthma, epilepsy, seizures, etc.)
Yes
No
If yes, please explain.
___
_____________________________________
_____________________________________
_____________________________________
3. Has your child ever been tested for any of the following?
Yes
No
Learning Disabilities
Speech/Language Disabilities
Yes
No
Attention Deficit Disorder
Yes
No
Hyperactivity
Yes
No
Has your child ever taken Ritalin?
Yes
No
Place:
Place:
Place:
Place:
Place:
Date:
Date:
Date:
Date:
Date:
If you answered yes to any of the above, please share with us all information obtained from these evaluations. ________________________________
___________
4. Are there any situations or pertinent information that we should know in order to further understand your child?
Yes
No
If yes, please explain. _______________________________________________________________________________________
Nationally Recognized Blue Ribbon School 2006
St. Mary Magdalen Catholic School
Financial Responsibility Form 2013-2014
(Please Print)
Name of person
responsible for payment
of tuition (please print):
Student Name
Phones for
Responsible Party:
1
City,
State, Zip:
Street Address:
Home:
Work:
Registered Parish:
Responsible Party’s
Signature:
Grade for
2013-2014
Cell:
2
Envelope #:
3
Date:
4
Please Check the Appropriate Category for Your Family:
Materials Fee
Due on June 15, 2013
Tuition (11 Monthly payments July 2013 – May 2014)
Partner in the Mission - Families registered and supporting St. Mary Magdalen Parish / Families with Sister Parish Subsidy



1 child

$400
$12,078 yearly
$1,098 monthly
$400
3 children
$17,644 yearly
$1,604 monthly
$400
$21,230 yearly
$1,930 monthly
$400
$7,623 yearly
$ 693 monthly
$400
2 children
$15,246 yearly
$1,386 monthly
$400
3 children
$22,869 yearly
$2,079 monthly
$400
4 children
Non-Partner Families

$585 monthly
2 children


$6,435 yearly
1 child
Families must meet the St. Mary Magdalen
Parish Partner in the Mission membership
requirements as set forth by the Parish to
receive the Partner in the Mission tuition
rate. Please see the reverse side of this
form.
 I am applying for Parish/School Financial Assistance. (St. Mary Magdalen supporting parishioners only)
G.A.P. (Giving Annually Program)
2013 - 2014 School Year
The Giving Annually Program (G.A.P.) recognizes that each year the money raised
through tuition, registration fees and fundraisers DOES NOT cover the complete cost of
education at St. Mary Magdalen Catholic School.
We are asking for your help through a special donation to G.A.P.
any amount Pledged is much appreciated.
Cost of
Education
1 child

$ 7,623.00
St. Mary Magdalen
Partner in the
Mission Tuition
and Fees
$ 6,835.00
GAP
$
788.00
YES, I am willing to help St. Mary Magdalen Catholic School meet the financial needs of providing my
child(ren) with a quality Catholic education. I have checked the amount of my donation and payment
I desire in the space below.
$788.00
$500.00
$250.00
$125.00
Other $___________

I will pay the full amount now (check enclosed).

I will pay half of my commitment on July 1, 2013 and the other half on November 1, 2013.

I will pay 11 monthly GAP payments through my F.A.C.T.S tuition account.
$__________ monthly payment x 11 = $__________ total
[Example: $72.00 monthly payment x 11 = $792.00 total]

If your company has a matching funds program, please check here.

I am unable to make a commitment to the program at this time, please check back with me later in the
school year.
Print Name
__________________________Parent’s Signature_____________________
Address_______________________________________________Date _______________
Student Names: _________________________________________________________________
This GAP form is part of the registration process and must be completed and returned to the school office
with your application for admission in order for your child(ren)’s registration to be complete. Thank you for
your help.
869 MAITLAND AVENUE ∙ ALTAMONTE SPRINGS, FLORIDA 32701
PHONE 407.339.7301 ∙ FAX 407.339.9556
www.smmschool.org
St. Mary Magdalen Catholic School
KINDERGARTEN DEVELOPMENTAL
READINESS EVALUATION
2013 - 2014
Child’s Name _________________________________________ Birthdate _________________________
School Name _________________________________________ Telephone ________________________
Teacher’s Name ____________________________ Teacher’s Signature: ___________________________
(S) = Satisfactory
(P) = Progress Being Made
(N) = Needs Improvement
To the Teacher: Please place a checkmark in the box under the category that best describes the child’s development.
After completing the form, please return to
St. Mary Magdalen School, 869 Maitland Avenue, Altamonte Springs, FL 32701.
TASK
S
P
N
Listens and pays attention for short periods of time.
Follow simple directions.
Shares and takes turns.
Accepts some responsibility for actions.
Is able to remember and obey simple classroom rules.
Expresses feelings appropriately.
Sits and listens to short stories.
Completes assigned tasks.
Exhibits appropriate gluing and cutting skills.
Primary Language Spoken __________________________________________
In your professional opinion, do you feel that this child will be successful in kindergarten? Please explain. ____________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Have you discussed this child’s developmental level with his or her parents? ____________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
St. Mary Magdalen Catholic School
REQUEST FOR INFORMATION
PRIOR TO ACCEPTANCE
GRADES 1 – 8
2013 - 2014
Parents, please complete the top portion and submit this form to your child’s current teacher with a stamped envelope.
The teacher should mail the completed form to St. Mary Magdalen Catholic School, 869 Maitland Avenue, Altamonte
Springs, Florida 32701.
Name of Student _______________________________________________________ Current Grade __________
School Currently Attending ______________________________________________________________________
Address______________________________________ City ___________________ State ____ Zip Code _______
The student named above has applied for admission into the _____ grade at St. Mary Magdalen Catholic School for the
academic year 2012 – 2013.
To: Principal, Teacher or Counselor
Your help is requested in supplying as much of the information below as possible so that we can better meet the needs of
this student.
Length of time in this school _____________________Does student have a satisfactory attendance record? □ Yes □ No
Please grade the following
areas with a checkmark.
Excellent
Good
Average
Poor
General Attitude
Effort
Cooperation
Relationship with Teacher
Relationship with Peers
Emotional Maturity
Intellectual Development
General Health
Motor Control
Study Habits
Maturity Age Level
□ Early
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□ Average
□ Advanced
REQUEST FOR INFORMATION
PRIOR TO ACCEPTANCE
GRADES 1 – 8
2013 - 2014
Please provide the following curriculum and behavior information:
READING Series and present reading level of student; please explain: _________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
MATH Series and present math level of student; please explain: ______________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
PHONICS Series (type of program) and present level of child; please explain: ___________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please describe any disabilities, i.e., physical, emotional, mental, language barriers, family situations which may
affect this student’s progress. __________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please comment on classroom conduct and discipline: _____________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please comment on Behavior/Attitude, Work/Study Habits and Peer Relationships: _______________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Has the student ever been a recipient of a Special Services Program, i.e., a Learning Disability Resource Center,
Developmental Reading, English or Math Program or a Behavior Disorder Program? ____________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Has the student ever been referred to participate in such a program? □ Yes □ No
Parent attitude and degree of involvement; please comment: _________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Thank you for the time and effort you have taken in completing this evaluation. Your recommendations do have
bearing on our decisions.
Signature of Person Completing Report _____________________________________ Title _________________
Telephone _________________________________________ Date ___________________________________
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St. Mary Magdalen Catholic School
ad vitam paramus
TUITION AND FEE SCHEDULE
2013-2014
Registration Fee - $150 per family due upon initial enrollment in school.
Materials Fee - $400 per family is due June 15, 2013
Both fees are non-refundable.
PARTNER IN THE MISSION TUITION
Families meet all criteria for membership in St. Mary Magdalen Parish
Annual
Tuition Rate
$ 6,435.00
$12,078.00
$17,644.00
$21,230.00
Number of Children
1 child
2 children
3 children
4 children
11 Monthly Payments
July 2013 – May 2014
$ 585.00
$1,098.00
$1,604.00
$1,930.00
Non-Partner Tuition
Number of Children
1 child
2 children
3 children
4 children
Annual
Tuition Rate
$ 7,623.00
$15,246.00
$22,869.00
$30,492.00
11 Monthly Payments
July 2013– May 2014
$ 693.00
$1,386.00
$2,079.00
$2,772.00
869 MAITLAND AVENUE ∙ ALTAMONTE SPRINGS, FLORIDA 32701
PHONE 407.339.7301 ∙ FAX 407.339.9556
www.smmschool.org
St. Mary Magdalen Parish
Education Assistance Program
School Year 2013 – 2014
The procedure and timeline to request tuition assistance for the 2013 - 2014 school year
is as follows:
1. Complete and return your Financial Responsibility Form.
2. Complete the FACTS Grant and Aid Assessment application online at
www.factstuitionaid.com and submit ALL supporting documentation by March 15,
2013 to FACTS. Missing documentation will delay your submission until the date
all information is received.
3. Any tuition assistance offered, and the amount, will be mailed in a letter to each
requesting family beginning April 30, 2013*.
All applications will be processed through FACTS Grant and Aid Assessment
electronically and FACTS will submit a report to the Parish office for consideration.
Eligible** tuition assistance requests will be considered solely on the basis of
demonstrated need (as funds are limited). All completed applications received by the
March 15, 2013 deadline will be considered as received simultaneously. Applications
received after March 15, 2013 will be considered on a first-come, first-serve basis.
If you have any questions regarding the information contained in this letter, please
contact the school finance office.
* Based on application submission date, deadlines, and completeness of application
(including needed documentation).
**Must fulfill Partner in the Mission membership requirements as set forth by the Parish
to be eligible for tuition assistance. See reverse of this letter for membership
requirements.
St. Mary Magdalen Parish
Partner in the Mission
School Year 2013 – 2014
Who is a Partner in the Mission?
As a disciple (member) of the parish community, a partner attends and participates
weekly in the sharing of the Sunday Eucharist & the sacraments at St. Mary Magdalen.
As part of the community of believers, a partner is committed to personal spiritual
growth. This includes having a current Parish Census form on file with the Parish
Office.
A partner is committed to living out their call to discipleship within the community by
giving their time and talent on a regular basis to carry out the Lord’s work. A partner
completes the Time & Talent form each spring and serves in at least one area of parish
ministry throughout the year.
A partner financially supports the mission and ministries of the entire parish through the
Sunday and Holyday envelopes on a regular basis (weekly giving). Every Fall, each
partner household makes a sacrificial, financial pledge to support God’s work at St.
Mary Magdalen for the coming year. They fulfill their pledge throughout the following
calendar year.