Application for Admission
Thank you for your interest in the Durham Nativity School. Please thoroughly complete and submit this
application to our school office located at 1004 North Mangum Street in Durham. If you need any assistance,
please contact our Dean of Admissions at (919) 597-7792.
Applicant Information
Applicant’s Name ___________________________________________________________________
Last
First
Date of Birth _____/_____/_____
Age _____
Middle
Social Security Number ___________________
Applicant’s Home Address ____________________________________________________________
Number & Street
Apt. Number
City
____________________________________________________________
State
Applicant lives with: ___ Both Parents
Zip Code
___ Mother
Telephone Number
___ Father
___ Legal Guardian
___ Other
Does the applicant qualify for the Federal Free or Reduced Lunch Program at school? ___ Yes ___ No
Parent / Legal Guardian Information
Father’s Name _____________________________ Mother’s Name ___________________________
Last
First
Last
First
Cell Phone ________________________________ Cell Phone _______________________________
Is English the primary language spoken in your home? ___ Yes ___ No
If no, what language? _________________________________
School Information
Present School Name ________________________________________________________________
Present Teacher ____________________________________________________________________
Has your child ever been placed on an IEP and enrolled in any type of special education program, speech
program, or counseling program at the school he attends? ___ Yes ___ No
If yes, please explain. _______________________________________________________________________
_________________________________________________________________________________________
Has your child ever been suspended (in school or out of school)? ___ Yes ___ No
If yes, please explain. _______________________________________________________________________
_________________________________________________________________________________________
PARENT SIGNATURE
The information provided on this application is accurate and complete. All information and documentation
obtained during the admission process becomes the property of Durham Nativity School and is considered
confidential between DNS and the source of the information. I understand that Durham Nativity School seeks
to admit only students whose educational needs it has the resources to meet and that Durham Nativity School
does not discriminate in admission on the basis of race, color, creed, ethnic or national origin.
Signature _________________________________________ Date ___________________________________
Application Requirements

Completed Application

2 Teacher Recommendations (current teacher and previous teacher)

Permission to Forward School Records Form

Copy of Most Recent Tax Return (1040 or W2)
Completed applications for admission are to be hand delivered to the school or mailed to:
Dean of Admissions
Durham Nativity School
P.O. Box 3537
Durham, N.C. 27702
Teacher Recommendation
Name of Applicant ___________________________________________________________________________
Applicant’s Current Grade
All information on this recommendation form is considered confidential
The student listed above is a candidate for admission at Durham Nativity School. We appreciate your cooperation
in completing this form. We would like to create the best match of child, school and placement.
Please leave blank any sections that do not pertain to your relationship to the applicant. Please note that the
recommendation must be received before a decision can be made. Mail this completed form to
Dean of Admissions
Durham Nativity School
P.O. Box 3537
Durham, N.C. 27702
What is your relationship to the applicant?_________________________________________________________
How long have you known the applicant?
Please rate this student in the following areas.
Always
Demonstrates positive attitude toward learning
Works well independently
Seeks help when necessary
Is thorough in completing assignments
Is punctual in completing assignments
Interacts positively with peers
Responds positively to constructive criticism
Shows respect and consideration for others
over
Most of the Time
Sometimes
Never
Please answer the following questions to the best of your knowledge.
1. What are the first three words that come to mind when characterizing this student?
____________________
____________________
____________________
2. Please list the applicant’s talents and strengths.
________________________________________________________________________________
________________________________________________________________________________
3. Please list the applicant’s weaknesses.
________________________________________________________________________________
________________________________________________________________________________
4. What advice would you offer a colleague working with this student?
________________________________________________________________________________
________________________________________________________________________________
5. To your knowledge, does the applicant require any special assistance/accommodations to meet
academic requirements?
________________________________________________________________________________
________________________________________________________________________________
6. Is there any additional information that would be helpful in considering this student for admission?
________________________________________________________________________________
________________________________________________________________________________
Name ________________________________________ Title/Position __________________________
School ________________________________________ Phone _________________________________
Address __________________________________________________________________________
Street
City
Zip Code
Signature ________________________________________________________________________
Permission To Forward School Records
Student’s Name _____________________________________________________________________
Last
First
Date of Birth _____/_____/_____
Middle
Current Grade _____ Current Academic Year __________
School Releasing Records: ___________________________________________________________
Name of School
___________________________________________________________
Street Address
___________________________________________________________
City
State
Zip Code
___________________________________________________________
Telephone
Permission for Release of Records
Parents/guardians: Please complete this form and return it to the Durham Nativity School
I hereby grant permission to
(applicant’s current school)
to release my son’s school
records to Durham Nativity School for purposes of admission.
______________________________________________________________________
Parent/Guardian Signature
Date
To the student’s current school:
Please forward the following information to the address listed below. All application materials must be on file
before a decision can be made on this student’s admission to Durham Nativity School. Thank you for your
prompt response.



Final Report Cards
End of Grade Test Scores
Current Progress Reports
Dean of Admissions
Durham Nativity School
P.O. Box 3537
Durham, N.C. 27702