Mother Caroline Academy & Education Center

Mother Caroline Academy is a private, tuition free school for girls in grades 4-8 from limited financial means.

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Admissions Form

MCAEC Admission Application

Step 1 of 10

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Applicant Name*
First Middle Last
Grade*
Please enter a number greater than or equal to 0.
Address*
Street Address City State ZIP Code
Phone Number*
Student Email*
Parent/Guardian Email*
Student Ethnic Background*
- African American (Not Hispanic)
- African
- Caucasian
- Asian or Pacific Islander
- Latina
- Carribbean Islander
- Other
For statistical purposes only. Please check all that apply.
Country of Origin*
How did you hear about Mother Caroline Academy?*
- Current Student/Parent
- Friend
- Family Member
- Radio
- Newspaper
- Flyer
- Other
If selected Other, please specify

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Parent/Guardian 1
Name*
First Last
Address*
Street Address City State ZIP Code
Home Phone*
Occupation*
Employer
Education Level*
Work Phone
Cell Phone
Place of Birth*
Guardian Email*

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Parent/Guardian 2
Name
First Last
Address
Street Address City State ZIP Code
Home Phone
Occupation
Employer
Education Level
Work Phone
Cell Phone
Place of Birth
Parent/Guardian Email
Applicant Resides With*
Relationship*

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Family Information
Siblings
Name Age Grade School Live At Home?

To add additional sibling entry, click the '+' icon to the right.
Religion
Parish or Church

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Financial Information
To be considered for acceptance to Mother Caroline Academy, both parents must submit copies of their most recent income tax forms (1040) and complete the additional information on the page below.
Guardian 1: Total Yearly Salary/Wage*
Guardian 1: Unemployment Compensation*
Guardian 1: Child Support / Alimony*
Guardian 1: Veteran Benefit*
Guardian 1: Social Security*
Guardian 1: Disability Benefits*
Guardian 2: Total Yearly Salary/Wage
Guardian 2: Unemployment Compensation
Guardian 2: Child Support / Alimony
Guardian 2: Veteran's Benefit
Guardian 2: Social Security
Guardian 2: Disability Benefits
Annual Family Income*
Income Verification*
Please provide a document that validates your entry.

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Residential Information
Do you own your home?*
- Yes
- No
Do you rent your home?*
- Yes
- No
What amount of rent or mortgage do you pay each month?*
Do you receive housing assistance? (for example Section 8)*
- Yes
- No
Do you or your daughter have MASS Health for insurance?*
- Yes
- No
If Yes, what is your monthly contribution for MASS Health?
Is your family receiving any type of transitional assistance?*
- Yes
- No
How is income received?*
- Social Security
- TANF
- Disability
- Child Support
- Unemployment
List ALL Household Members*
Name Relation to Applicant Age

To add additional entries for household members, click the '+' icon on the right
Provide estimated information below for all dependent children/family living in home*
Name Grade School Tuition Amount you Pay

To add additional entries for each child, click the '+' icon on the right
Special Circumstances
Please list any special circumstances or financial situations (such as medical or tuition costs, special circumstances involving employment, etc.) the Admission Committee should be made aware of
Certification

I hereby certify, under penalties of perjury, that the information contained in this Financial Information Form is true, correct and complete to the best of my knowledge and belief. I understand that if the information contained herein subsequently proves not to be true, correct and complete, it may cause my child’s admission to be revoked and myself prosecuted or sued for fraud.
Electronically Sign Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Phone*

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Academic Information
Name of Current School*
School Type*
- Public
- Private
- Parochial
- Charter
- Other
If selected Other, please specify
Address of Current School*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone of Current School*
Name of Principal/Head of Current School*
First Last
Previous Schools*
School Name Grade Start Grade End Date Started Date Ended

To add another school, click the '+' icon next to the right of the entry.
Relative Alumni
Name Date Started Date Ended Relation to Applicant

To add another entry for schools, click the '+' icon on the right

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Note to Parents/Guardians
The purpose of this questionnaire is to help the Admissions Committee decide if Mother Caroline Academy can appropriately meet the needs of each applicant. All information furnished byparents/guardians is confidential.
What are your thoughts about parent engagement in your child’s education?*
How do you plan to support your daughter if she is accepted to Mother Caroline Academy?*
Does your child have an IEP (Individualized Education Plan?)*
- Yes
- No
If yes, when was the IEP issued
Date Format: MM slash DD slash YYYY
Has your child received any special academic support either inside or outside her current school program during the past 3years?*
- Yes
- No
If yes, please describe. You may include additional documentation.
Has your child been tested by a learning specialist, child study team or other trained evaluator during the past 3 years?*
- Yes
- No
If Yes, please furnish a copy of the testing report
Is there any illness or disability, which may interfere with your child’s participation in extracurricular activities?*
- Yes
- No
If yes, please indicate what they are (asthma, allergies, diabetes, etc.) and explain

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Parent Essay
Please describe a moment where you saw your daughter shine and what you feel was one of her proudest accomplishments.*
Mother Caroline Academy requires that parents/guardians or family memberscontribute 20 hoursof serviceduringthe course of the academic year. These 20 hours of service are known as Parent Partnership Points. We provide various opportunities for parents to earn those hours/pointsby participating in parent workshops, classroom activities, fundraising, helping with breakfast etc... What type of service would you be interested in?
Parent/Guardian Signature*
Date*
Date Format: MM slash DD slash YYYY
This application is an expression of intent only and is not binding upon the parents/guardians or Mother Caroline Academy. Mother Caroline Academy complies with all state and federal anti-discrimination laws in our admissions process.I/We submit this application (including the section on family information) with an understanding and acceptance of all the rules, conditions and requirements of the school. I/We understand that this application is only an expression of interest and is not binding.It is my understanding that Mother Caroline Academy is an academically challenging school with a rigorous code of conduct and that full participation of parents or guardians (including attending classes, attendance at faculty/parent meetings, evening study, field trips, and other parent and family activities) arenecessary in to order to meet the requirements of the program*
I agree.
This application is an expression of intent only and is not binding upon the parents/guardians or Mother Caroline Academy. Mother Caroline Academy complies with all state and federal anti-discrimination laws in our admissions process.I/We submit this application (including the section on family information) with an understanding and acceptance of all the rules, conditions and requirements of the school. I/We understand that this application is only an expression of interest and is not binding.It is my understanding that Mother Caroline Academy is an academically challenging school with a rigorous code of conduct and that full participation of parents or guardians (including attending classes, attendance at faculty/parent meetings, evening study, field trips, and other parent and family activities) arenecessary in to order to meet the requirements of the program
Policy of Non-Discrimination

Mother Caroline Academy admits students of any race, color, nationality, religion and ethnic origin to all rights, privileges, programs and activities generally accorded or made available at the school. Mother Caroline does not discriminate on the basis of race, color, nationality,religionor ethnic origin in the administration of its educational policies, scholarships, athleticsand other school administered programs.
Application materials should be mailed or returned to:

Mother Caroline Academy
Admission Committee
515 Blue Hill Avenue
Dorchester, MA 02121

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Student Questionaire
This section is to be answered by the student applicant
Name*
First Middle Last
Preferred Name
Your present school:*
Years Attended*
Please enter a number from 0 to 10.
What do you like best about school? Why?*
List the four best books you read during the past year. Which ones were assigned by your school and which ones did you read on your own?*
Please list any activities that you regularly participate in outside of school (music, sportsetc...)-PLEASE USE FULL SENTENCES*
Student Essay
In at least three paragraphs, please write about the following: A magazine wants to interview you about your life and would like you to tell them who your hero is and why. What would you tell them? PLEASE USE COMPLETE SENTENCES*
Student Signature*
Date*
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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515 Blue Hill Avenue, Dorchester, MA 02121 | Phone: 617-427-1177 | Fax: 617-427-7788

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Name	Age	Grade	School	Live At Home?

Name	Relation to Applicant	Age

Name	Grade	School	Tuition	Amount you Pay

School Name	Grade Start	Grade End	Date Started	Date Ended

MCAEC Admission Application

Step 1 of 10

Parent/Guardian 1

Parent/Guardian 2

Family Information

Financial Information

Residential Information

Certification

Academic Information

Note to Parents/Guardians

Parent Essay

Policy of Non-Discrimination

Student Questionaire

Student Essay