Entrance Exam

Christopher Columbus High School
Make-up Entrance Exam Application 2010/2011
Tuesday, April 20, 2010 (2:30pm)

If you do not wish to register Online Click Here to Print Mail in Form

Student Information:

Last Name:

First Name:

Middle Name:

Address:

City:

State:

Zip:

Home Phone:

Mother's Name:

Business or Cell Phone:

Father's Name:

Business or Cell Phone:

Custodial Parent's Email:

Student's Email:

Is Father a Columbus Alumnus? :	YesNo
If yes, please specify Grad Year:

Is Brother a Columbus Student/Alumnus? :	YesNo
If yes, please specify Grad Year:

What grade level are you applying for?:

91011

Do you have a Florida High School State Scholarship?:	YesNo
Identify:	McKayFlorida PrideOther

School Presently Attending:

Schools since 6th grade:

Has the child ever been tested for learning disabilities?:	YesNo	Date Tested:
(If yes, please expain):

Statement to Verify Appropriate Status: After September 11, 2001, the Department of Homeland Security (BCIS) expects the schools to have complete and accurate information pertaining to any foreign student entering their school. We must make sure that our students have the appropriate status that allows them to attend school in the United States. Students who are changing their "tourist B-1" status to a "student F-1" status should have their status granted before attending school.

Payment Information:
The cost to register for the Columbus Entrance Exam is $50.

You can pay by credit card by filling out the information below.

Pay By:

Name of Credit Card Holder:

Credit Card Number:

Card Expiration:

Card CVV2:

If you have any questions regarding registration, please contact Becky Rafuls at 305-223-5650 x2239. For admissions questions contact Br. Ken Curtin at extension 2217.