Application for the 2017-2018 School Year
For the application to be considered for admission, the required grade appropriate records and a non-refundable $50 application fee (cash or money order) must be submitted.
Please Print Clearly
Today’s Date ______Applying for Grade ______In September 2017
Child’s Age on August 31, 2017______For 3s & 4s: _____ Half day _____ Full day
Student’s Legal Name ______Gender_____
First Middle Last
Street address ______City ______Zip ______
Tel. # ______
Date of Birth ______
Place of Birth ______
Transferring from (School/Day Care)______
School’s Address ______
Father: Name ______
First Middle Last
Address (if different)______
Father’s place of employment______
Occupation______
Work telephone no. ______Religion ______
Cell phone______Home phone______
(If different from above)
E-Mail Address ______
Mother: Name ______
First Middle Last
Address (if different) ______
Mother’s place of employment______
Occupation______Work telephone no. ______Religion ______
Cell phone______Home phone______
If Different from Above
E-Mail Address ______
Child is Living With: (Please check one)
______Both parents ______Legal Guardian
______Mother only ______Mother & Step-Father
______Father only ______Father & Step-Mother
______Foster Home ______Other (Please Specify)
Child resides in two households: ______
Relationship(s) Relationship(s)
Has your child ever undergone any formal evaluation? Please check all that apply.
_____ Educational _____Medical _____Psychological _____Social
Has your child ever been retained? ____ yes ____no ______School ______Year
Has your child ever had a conduct problem, which resulted in
______Suspension ______Expulsion ______No Conduct Problems
List all schools that your child has attended:
Name of School Grade Years
______
______
______
Has your child attended a school in the Baltimore Archdiocese? If yes, please list ______
Child’s Religion ______
Church to which you belong ______
Street Address ______
City, State, Zip Code ______
Pastor’s Name ______
List child’s siblings. Begin with oldest. Please give names, dates of birth & school sibling attends.
1. ______
2. ______
3. ______
List other members of your household and relationship to student
______
Parent/Guardian Signature ______Date ______