Trinity Catholic High School

Please complete the form below. Mandatory fields marked *

Student Information

* Has your address changed? Yes No
* Grade
* Student's Last Name * First Middle
* Social Security #
* Mailing Address
* City * State * Zip
* Physical Address
* City * State * Zip
* Home Phone Number
* Gender Male Female
* US Citizen Yes No
* Date of Birth (Mo/Day/Year) * Age
* Place of Birth (City/State/Country)
Religion
Church of Attendance
Pastor's Name Address
* Race/Ethnicity Caucasian African-American Hispanic
Asian/Pacific American Indian Other

Family Information

* The student lives with: Both Parents
Mother
Father
Other Gaurdian
* Parents status Parents Married
Parents separated
Father has custody
Mother has custody
Joint custody
Other Gaurdian custody

Father
Last Name First Name
Mailing Address (if different from student)
City State Zip
Phone Mobile Phone
Mother
Last Name First Name
Mailing Address (if different from student)
City State Zip
Phone Mobile Phone

Father
Last Name First Name
Mailing Address (if different from student)
City State Zip
Phone Mobile Phone

Mother
Last Name First Name
Mailing Address (if different from student)
City State Zip
Phone Mobile Phone

Other Gaurdian
Last Name First Name
Mailing Address (if different from student)
City State Zip
Phone Mobile Phone
Relationship to student

* Access to Internet: Yes No

* Email address (if none, state "none")

Work

Father
Father's Occupation/Firm
Father's Business Address
Father's Business Phone
Father Business Owner Yes No
Mother
Mother's Occupation/Firm
Mother's Business Address
Mother's Business Phone
Mother Business Owner Yes No

Alternate Emergency Contacts

Contact 1
* Name
* Phone #
Work Phone #
Cell #
* Relationship to Student
Contact 2
Name
Phone #
Work Phone #
Cell #
Relationship to Student
Contact 3
Name
Phone #
Work Phone #
Cell #
Relationship to Student
In case of accident, serious illness, dismissal, or other administrative reasons, I request the school to contact me. If the school is unable to reach me at home or at work I hereby authorize the school to contact the above emergency contacts and follow his/her instructions.

Medical History

Florida State law requires that all students have on file a current Florida Certificate of Immunization (Blue Card - HRS 680) in order to attend classes. This card can be obtained from the Health Department or any physician in Florida.

* Local Physician's Name (State "none" if none)
Physician's Phone #
* Is your child on any medication? Yes No

Name of Medication
If so, for what?

List any condition your child may have that should be brought to the attention of all personnel in case of a reaction, flare-up, etc., i.e. (allergic reaction, diabetic, epileptic, asthmatic, etc.)

Insurance Information

* Name of Insurance Company (if none state none)
Insured Identification
Group Name or Number

Academic Information

Schools student attended in last three years:

School 1 *
* School
* Address
* Dates
* Completed Grade
School 2
School
Address
Dates
Completed Grade
School 3
School
Address
Dates
Completed Grade

Academic History

* Has student ever repeated a grade, skipped a grade, or been accelerated in instruction? Yes No
If yes, please describe the circumstances
* Has the student ever been referred for academic evaluation, testing or remedial instruction? Yes No
If yes, please describe the circumstances
* Has student ever been suspended from school? Yes No
If yes, please describe the circumstances
* Asked to withdraw? Yes No
* Dismissed from school for any reason? Yes No
Parent's Confidential Remarks: Please make the school aware of any physical, mental, or social conditions which will enable us to better help your child. The school cannot be held responsible for complications resulting from any unreported existing medical conditions.
Siblings:
Brother/Sister 1
Names of Brother/sister
Age
Grade
School Attending
Brother/Sister 2
Names of Brother/sister
Age
Grade
School Attending
Brother/Sister 3
Names of Brother/sister
Age
Grade
School Attending

TCHS Information Sheet

Registration: The registration fee is $450.00 and is non-refundable and is payable with this application. A deposit for one-half of this amount will be accepted if you cannot make the full payment. The remainder of the deposit is due before May 1, 2010. Students registering after the end of the school year must make arrangements with Ms Rubio, the Business Manager. She can be contacted at mrubio@tchs.us or 352-622-9025 ext 1112.

After the last day of registration the fee will increase by $50.00. Financial aid must be applied for by April 15th. Financial aid forms are available in the main office.

Tuition: The 2010-2011 tuition is $7720.00 for Catholics registered and participating in a parish and $9570.00 for all others. Tuition may be paid annually, monthly or by the semester. During the registration process Ms Rubio will be able to answer financial questions or concerns.

Student Financial Aid: Families registered who are unable to pay full tuition may apply for financial aid. Submitting an application does not guarantee financial assistance. Financial aid is given for tuition and is based on tuition it does not include any fees.

The available funding is:
1. SMART. - TCHS financial aid forms are available at the school or go to www.smarttuitionaid.com
2. Step Up for Students - (Income based) You can pick up forms at the school or go to www.stepupforstudents.org
3. McKay Scholarships - For students with Disabilities (IEP) - go to www.floridaschoolchoice.org

Funded Depreciation: The funded depreciation fee for 2010-2011 is $225.00 per student, payable by October 31, 2010.

Transportation:
The school has bus service for
Citrus County - The cost of this service is $160.00 monthly.
Lake County - The cost of this service is $130.00 monthly.

Textbooks: The rental fee for textbooks will be $320.00 plus consumables due by August 20, 2010

Graduation Fee: $200.00

Family Commitment

* Family Name
Mother Father
* Address
* Phone
Names of Children who will be attending and grade entering
Name Grade
Name Grade
Name Grade
Name Grade
Trinity Catholic High School exists to provide a Catholic environment by which parents are supported in their primary duty to educate their children in faith and morals. In signing this card, the family and/or the pastor agree that each party is an integral part of this commitment.

You must select one of the following:
We are members of and the parish agrees to pay.
Blessed Trinity
St. John
Queen of Peace
St. Paul Other
Other
The church agrees to pay Full Cost Half Cost Other

We are of the Catholic faith and support the parish; therefore we agree to pay the full Catholic cost of education ($7720.00) unless arrangements are made through our parish for monetary support.
We agree to pay the full non-Catholic cost of education ($9570.00), because we are not supporting members of a Catholic parish/we belong to another faith.

Method of Payment Self
SMART Tuition payment program
Applied for financial Aid
Applied for Step Up For Students
Filed intent for MCKAY Scholarshi
Financial responsibility will be assumed by:
Name
Street Address
City State Zip
Telephone

Tuition Payment

1. Families whose tuition is FULLY paid by a church in select Option 1.

2. Families who are NOT FULLY paid for through Blessed Trinity, Queen of Peace, St. Paul, St. Timothy , other parish or who are registered members of another Catholic parish shall make tuition payments at the Catholic rate

3. All families shall be expected to make tuition payments according to one of the following payment plans.

You must choose one:

Option 1: Full payment - Under this plan the entire amount of tuition is paid on or before the first day of school. A tuition reduction of 3% will be applied to the tuition cost for each child a family enrolls.
Option 2: Semester Payments - Two payments, the first due July 15 and the second payment is due January 15.
Option 3: Monthly Payments - SMART- Under this plan the entire amount of tuition is paid monthly over a ten month period beginning in July and ending in April. With the automatic withdrawal plan (ACH) your account will be debited on the 5th or 20th of the month (your choice).

Please complete the SMART Automatic Tuition Payment Agreement form. The SMART Agreement form must be returned to the school office by May 31st. If you have any questions, please contact the school office at (352) 622-9025.

NOTE:If you select option 1 or 2 and payment is not made by due date, then payment will have to be made through the smart payment plan.

I agree to make tuition payments for the 2009-2010 school year according to one of the options above. I have read the school policy regarding payment and agree to abide by this policy.

Tuition Policy

It shall be the responsibility of each family to keep the school Business Manager informed of their need to make any changes in their preferred tuition payment plan. The following will apply to late tuition payments.

1. Full Payment-If payment is not received on or before July 15th the discounted tuition rate will not apply. When full payment has not been made by July 15th the family will be contacted by the school Business Manager concerning the missed payment and alternative tuition payment options will be offered. If funds are not received according to the new agreement, all tuition payments shall be made through the SMART Tuition Management Plan.

2. Monthly Payments- School families who choose the ten (10) month payment plan and miss a monthly payment will be charged a $30.00 late fee by SMART The missed payment will be processed again by SMART on the next available payment date. In addition, school families who miss two (2) monthly payments and have not made suitable arrangements will be informed of the course of action the school administration decides upon as discussed in the "Tuition Delinquency" section of this policy.

Tuition Delinquency
School families failing to pay tuition according to the agreement they have made with the school and who have been unwilling to make suitable alternative arrangements will be informed that their student may not be readmitted to our school. In some cases, students may not receive report cards; permanent records may not be released by the school administration, and the student may not be allowed to take semester examinations.

Tuition Refunds
Families that withdraw students after the first day of school will have tuition prorated over the number of school weeks the student was in attendance according to a formula established by the school administration.

*TUITION IS DUE AND PAYABLE BY THE FIRST DAY OF SCHOOL DIRECTLY TO THE SCHOOL

Dear Parents/Guardians:

Trinity Catholic High School participates in several Federal programs that provide your children with a variety of materials and services. It is one of the few ways in which they receive benefits from your tax dollars and we certainly do not want to lose them. Please review the survey below and simply answer YES or NO to the question of family size, income, and then give your ADDRESS and GRADE(s) of your child/children. Your name is not required; however, your ADDRESS is vital. Income and geographical location determine the amount of these funds. We must have 100% participation in order to qualify.

Thank you for helping us provide your children with the best possible educational opportunities.

Sincerely,
Br. Daniel Aubin, F.S.C., M.Ed.
President

Size of Family	Weekly	Monthly	Annually
1	271	1,174	14,079
2	365	1,579	18,941
3	458	1,984	23,803
4	552	2,167	28,665
5	645	2,794	33,527
6	739	3,200	38,389
7	832	3,605	43,251
8	926	4,010	48,113
For each additional member add:	+94	+406	+4,862

Private School Family Survey
* Looking at the chart above, is your annual income less than the
amount listed for the number of persons in your family? Yes No
Address of Family (name not required)
* Address
* City * State * Zip
Grade level of each child in 2009-2010
Child #1 Child #2 Child #3
Child #4 Child #5 Child #6

Parent Involvement Program

Trinity Catholic High School has a Parent Involvement Program, or otherwise known as PIP. The Parent Involvement Program offers a unique approach to the cooperative effort of parents, students, faculty and administration as a way of building community in the fellowship of the Holy Spirit. Parents are encouraged to become involved in the life of Trinity Catholic, according to their talents and interests. This program is pertinent to Trinity Catholic in keeping the cost of education to a minimum. The cost to educate a student at TCHS is approximately $10,000 per year, and as many of you are aware there is a gap between the cost to educate a student and the actual tuition collected. Each family with a student at TCHS will be required to commit to ten (10) hours of service. Opportunities for involvement will be available in many areas of school life, including social activities, fund raisers, sports activities, clerical help and special events sponsored by the Development Office. This service may also be fulfilled through a monetary or in-kind donation of $20 per hour.

Example of Opportunities for PIP Hour fulfillment:
- Car Raffle
- Open House
- Golf Tournament
- Catholic Schools Week
- Carnival
- Administration Assistants
- Lunchroom Assistants
- Emerald Ball

* I have read the above statement concerning the Parent Involvement Program and understand that I will be required to commit tten (10) hours of service or pay the monetary portion of $20 per hour for hours not completed.

* I understand that registration forms will not be processed until Registration payment is made.

* Parent/Gaurdian Initials