Supplemental Student Information Sheet

DOHN COMMUNITY HIGH SCHOOL
608 East McMillan Street Cincinnati, Ohio 45206
Telephone: 513 281-6100 Fax: 513 281-6103
 
Supplemental Student Information Sheet
 
Name of Student: ____________________________________________________
                                (Last Name)                                  (First Name)                       
 
School year student started the 9th grade:_________________ (Month and year student first enrolled in the 9th grade)
 
Previous high schools attended (9th grade students should list their 8th grade school).
________________________________________________________________________
Name of School                                               Grade                  School Year Attended
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________
 
________________________________________________________________________
 
Has the student . . . . . (check statements that apply)
 
___ received special education services or been on an IEP
___ participated in the free or reduced lunch program at his/her previous school
___ been arrested for a drug/alcohol related offense
___ ever been expelled from a school (give reason in the space below)
___ ever failed a class in high school  (list classes in the space below)
___ ever repeated a grade in high school (indicate grade/s_________)
 
 
 
 
Checking any item does not automatically disqualify a student from attending Dohn Community High School.
  
To the best of our ability, I have provided complete and accurate information on this application form.
 
Signature of parent/guardian:________________________________ Date:_______