Application Form 2012 13 1

Application Form

dATE rECEIVEd
FOr OFFICE UsE ONLY

FEE

APPLICANT’s LEgAL NAME LAsT FIrsT MIddLE INITIAL

MAILINg AddrEss sTrEET CITY sTATE zIP

COUNTY PHONE

BIrTH dATE AgE sEX M F

rELIgION PArIsH (if Catholic)

sCHOOL PrEsENTLY ATTENdINg APPLYING FOR GRADE

sCHOOL AddrEss sTrEET CITY sTATE zIP

Check the program for which you would like to be considered.
(Note: Additional requirements for ryken are outlined in the ryken section.
If not admitted to Honors, applicant will automatically be considered for College-Prep.)

Xaverian Honors College-Prep ryken

Mr./dr.
FATHEr’s NAME
LAsT
FIrsT
MIddLE
FATHEr dECEAsEd
NOT LIVINg wITH FATHEr

OCCUPATION NAME OF EMPLOYEr wOrk PHONE

wOrk AddrEss sTrEET CITY sTATE zIP

YEs NO
FATHEr A gOOd COUNsEL grAdUATE? IF YEs, YEAr OF grAdUATION

Mrs./Ms./dr.
MOTHEr’s NAME
LAsT
FIrsT
MIddLE
MOTHEr dECEAsEd
NOT LIVINg wITH MOTHEr

OCCUPATION NAME OF EMPLOYEr wOrk PHONE

wOrk AddrEss sTrEET CITY sTATE zIP

YEs NO
MOTHEr A gOOd COUNsEL grAdUATE? IF YEs, YEAr OF grAdUATION

Additional immediate family members who have attended or are currently attending good Counsel (include date of graduation and relationship to applicant)

APPLYING FOR FINANCIAL AID? YEs NO SUBMITTED A FINANCIAL AID APPLICATION? YEs NO (e decision for acceptance is independent of financial aid application)

17301 Old Vic Boulevard I Olney MD 20832 I 240-283-3235 I www.olgchs.org
Application Form continued

List any organizations, clubs and activities with the school or community in which the applicant has participated during the last two years. Mention any awards received in these activities.

Essay
Our Lady of good Counsel’s philosophy states: “In today’s world, the loving good person, even alone, can make a difference.” In 250 words or less, describe how you plan to make a difference in the good Counsel community.
(Attach typed essay to application and include applicant and parent signatures along with the $50.00 application fee. If you apply online the signature requirement is waived.)

APPLICANT sIgNATUrE dATE

sTUdENT E-MAIL AddrEss

PArENT Or gUArdIAN sIgNATUrE dATE

PArENT E-MAIL AddrEss

Incoming Freshman Applications must be postmarked to good Counsel by December 12, 2014. return to Our Lady of good Counsel High school
Attn: Office of Admissions, 17301 Old Vic Boulevard, Olney, Md 20832

ARCHDIOCESAN STUDENTS MUST:
• submit a completed application
• Mark good Counsel as a choice on the High school Placement Test

NON-ARCHDIOCESAN OF WASHINGTON STUDENTS MUST:
• submit a completed application
• register to take the High school Placement Test and mark good Counsel as a choice
• send Transcript release Form and recommendation Forms to current school