CATEGORY “A” DATA ARCHDIOCESE OF MILWAUKEE CUMULATIVE RECORD KEEP PERMANENTLY

Form # E122 Policy Code: 5125.2 [DE-SU-7 (86) ]

Student Name :

Birth : Last First Middle Year Month Day M F

Father (Guardian) : Mother (Guardian) :

(Maiden Name)

Attendance Record

Admission and Transfer Data Name of School / Program City State Date

Entered from:

Admitted to:

Transferred to:

Transferred to:

Transferred to:

CATEGORY “B” DATA

Father (Guardian) Religion: Occupation:

Mother (Guardian) Religion: Occupation:

Names of other children (oldest first)

ARCHDIOCESE ACHIEVEMENT TESTING RESULTS: INSERT SCORE STRIPS BEGINNING HERE/ ALSO USE OTHER SIDE

Grade 3 IOWA or other

ARCHDIOCESE ACHIEVEMENT TESTING RESULTS: INSERT SCORE STRIPS BELOW: Grade 3 IOWA previous page

Grade 3 COGAT or other Grade 5 COGAT or other

Grade 4 IOWA or other

Grade 5 IOWA or other

Grade 6 IOWA or other

Grade 7 IOWA or other

Grade 7 COGAT or other

Grade 8 IOWA or other

Address Phone

Grade Level Completed

1. Year ending

2. Days Present

3. Days Absent

4. Times Tardy