ReGeneration Fawahodie House- NCAS

Prince George's County, MD
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Student Information
Student's Name*

First NameLast Name
Gender*

MaleFemale
Date of birth*

DayMonthYear
Place of birth*
City, State
Student Address*

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Phone Number*

Country CodePhone Number
Requested Admissions Year*

2023-20242024-2025
Requested Starting Term*

Quarter I (Sept. 11, 2023)Quarter II (Nov. 27, 2023)Quarter III (Feb. 5, 2024)Quarter III (April 29, 2024)SY 2024-2025
Enrollment Type*

RFH @homebaseRFH @homebase (P/T)

Give a brief description of the service or assistance you would like to provide. Include your experience and/or training.
Is it possible to provide this service virtually?
Parent/Guardian Details
Parent / Guardian 1*

First NameLast Name
Relationship to student*
Is the student your biological kin?*
Email*
example@example.com
Home Address (Same as student? If no, please specify below)*

YesNo
Parent 1 Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodePhone Number
Email*
example@example.com
Profession/ Line of Work*
Please tell us what you do : )
Parent / Guardian 2

First NameLast Name
Relationship to student
Is the student their biological kin?
Home Address (Same as student? If no, please specify below)

YesNo
Parent 2 Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Country CodePhone Number
Profession/ Line of Work
Tell us what they do : )

Parent- Sentence Completion

The following sentences concern your perspective/perception based on your experiences. Complete the unfinished sentences with the first thing that comes to your mind. There are no right or wrong answers, so please try to answer openly and honestly. You may skip any items that you cannot readily complete, but all sentences must be complete before going forward to the next page.
Our household FAMILY CULTURE is...*
I am interested in this school program because...*
I am happy that my child is...*
Good character...*
My personality is...*
The "me" that others see...*
The "me" that others may not see...*
I am working on...*
I want my child to be...*
My dreams...*
I get frustrated with parenting when...*
My support comes from...*
My ability to *deal* with the opposite gender...*
My ability to *deal* with the same gender...*
Community means...*
I teach my child...*

Parent- Sentence Completion