Name and Address of person responsible for tuition/fees payment: Name Home Address City State Zip Marital Status: Married Single Separated Divorced* Mother deceased Father deceased Father remarried Mother remarried *Note: In the event of a divorce, decree of custody must be filed in the school office, as well as any specific instructions regarding release of the child to a parent. Grandparent Information: Paternal: - - Name Phone Home Address City State Zip Maternal: - - Name Phone Home Address City State Zip Student lives with: Both Parents Mother Father Guardian (if checked, fill out below) - - - - Guardian Name Phone Cell Phone Home Address City State Zip - - Occupation Employer Work Phone Religion Parish Has your student ever been suspended, dismissed, expelled, or not permitted to re-enroll in a school? yes no If yes, please give the name of the school and explain the reasons on a separate sheet of paper. Has your student ever been tested or evaluated for any disability [i.e., Learning Disabilities, Attention Deficit (Hyperactivity) Disorder, Emotional Disabilities, etc.], English as a Second Language, or medical condition? yes no If yes, please describe on a separate sheet of paper any disability or medical condition that may affect the applicant’s ability to fully participate in the academic and/or other programs provided at our school. If applicable, please provide dates of IEP, Student Assistance Plan, Special Ed Child Study, Special Ed Eligibility Date from base public school and Special Ed Triennial. If you are requesting an adjustment or accommodation to allow participation to any program, please describe your request. Please provide sufficient evidence to allow us to assess your situation. We may request additional information from you and from an appropriate health professional. Information about disabilities is requested for the sole purpose of determining whether the school can provide the applicant with an appropriate education or reasonable accommodation and will not be considered in determining whether he/she is otherwise qualified for admission. The following optional but helpful information is for use in applying for Federal Grants and NCEA Data Bank Information:
Name and Address of person responsible for tuition/fees payment: Name Home Address City State Zip Marital Status: Married Single Separated Divorced* Mother deceased Father deceased Father remarried Mother remarried *Note: In the event of a divorce, decree of custody must be filed in the school office, as well as any specific instructions regarding release of the child to a parent. Grandparent Information: Paternal: Name Phone - - Home Address City State Zip Maternal: Name Phone - - Home Address City State Zip Student lives with: Both Parents Mother Father Guardian (if checked, fill out below) Guardian Name Phone - - Cell Phone - - Home Address City State Zip Occupation Employer Work Phone - - Religion Parish Has your student ever been suspended, dismissed, expelled, or not permitted to re-enroll in a school? yes no If yes, please give the name of the school and explain the reasons on a separate sheet of paper. Has your student ever been tested or evaluated for any disability [i.e., Learning Disabilities, Attention Deficit (Hyperactivity) Disorder, Emotional Disabilities, etc.], English as a Second Language, or medical condition? yes no If yes, please describe on a separate sheet of paper any disability or medical condition that may affect the applicant’s ability to fully participate in the academic and/or other programs provided at our school. If applicable, please provide dates of IEP, Student Assistance Plan, Special Ed Child Study, Special Ed Eligibility Date from base public school and Special Ed Triennial. If you are requesting an adjustment or accommodation to allow participation to any program, please describe your request. Please provide sufficient evidence to allow us to assess your situation. We may request additional information from you and from an appropriate health professional. Information about disabilities is requested for the sole purpose of determining whether the school can provide the applicant with an appropriate education or reasonable accommodation and will not be considered in determining whether he/she is otherwise qualified for admission. The following optional but helpful information is for use in applying for Federal Grants and NCEA Data Bank Information:
admissionapplication.docx