Student Information
Date:    Enrolling as: FreshmanTransfer StudentInternational Student
Enrolling in grade level: Date of Birth:
Name: MaleFemale Last First Nickname M.I.
Address: Street City State Zip
Home Phone (xxx) xxx-xxxx:
Religion: Parish Membership: [Please Select] All Saints - Denmark Annunciation Assumption BVM - Pulaski Atonement Lutheran Bay City Baptist Bayside Christian Fellowship Bethany - Methodist East Side Moravian Church Faith Lutheran First United Methodist First United Presbyterian Fox Valley Islamic Center GB Community Church Grace Lutheran - Oconto Falls Grace Lutheran - GB Harvest Community - Luxemburg Highland Crest Baptist Church Holy Apostle Episcopal Holy Cross Holy Rosary - Kewaunee Living Hope Church Meadowbrook Church Nativity Non-affiliated Old St. Joseph - De Pere Oneida Longhouse Our Lady of Lourdes Our Saviour Lutheran Peace Lutheran Pilgrim Lutheran Prince of Peace Redeemer Lutheran Resurrection Sacred Heart - Shawano Spring Lake Church SS Edward and Isidore SS Peter and Paul St. Agnes St. Benedict St. Bernard St. Elizabeth Seton St. Francis - De Pere St. Francis of Assisi St. Francis Xavier Cathedral St. John Lutheran - Little Suamico St. John the Baptist - Howard St. John the Evangelist - GB St. Joseph - GB St. Jude St. Kilian St. Louis - Dyckesville St. Martin - Cecil St. Mary of the Angels St. Mary - De Pere St. Matthew St. Patrick St. Philip St. Pius Trinity Lutheran St. Willebrord Synagogue Union Congregational Church West Side Moravian No Parish Other
Ethnic Background: AsianAfrican AmericanCaucasianEastern Indian HispanicNative AmericanBi-RacialOther
Current (or Most Recent) School: [Please Select] Aldo Leopold All Saints Bay City Baptist Bay View De Pere Denmark Edison Franklin Freedom Holy Cross Holy Family Holy Rosary - Kewaunee Home School International Student Lombardi Luxemburg - Casco Marinette Montessori Mt. Carmel Academy Notre Dame Oneida Nation Our Lady of Lourdes Out of Area Parkview Pilgrim Lutheran Providence Academy Pulaski Red Smith Redeemer Lutheran Resurrection Sacred Heart - Shawano Seymour St. Bernard St. Francis Cabrini - Manitowoc St. John the Baptist St. Joseph St. Matthew St. Philip St. Thomas More Trinity Washington Washington - Oconto Falls West De Pere Phone:
School Address: Street City State Zip
Parents' Marital Status: MarriedSingleSeparatedDivorcedWidowed
If marked Divorced is Mother RemarriedFather Remarried
If marked Separted or Divorced who will be responsible for paying tuition?
Student primarily lives with: Both ParentsMotherFatherOther Relative/Guardian
Information should be mailed to: Both ParentsMotherFatherOther Relative/Guardian
Has the student been diagnosed with learning disabilities? YesNo
If so, please complete and mail in the Special Needs Profile found with additional forms after submitting this application.
Father Information
Name: Mr. Dr. Title Last First Nickname M.I.
Address: Street City State Zip
Home Phone: Cell Phone: Work Phone:
Email Address (Please list the home or work address that you'd prefer to be contacted at):
Occupation: Employer:
Mother Information
Name: Mrs. Ms. Dr. Title Last First Nickname M.I.
Address: Street City State Zip
Home Phone: Cell Phone: Work Phone:
Email Address (Please list the home or work address that you'd prefer to be contacted at):
Occupation: Employer:
Host Family / Legal Guardian / Relative Information
Name: Mr. Dr. Mrs. Ms. Title Last First Nickname M.I.
Address: Street City State Zip
Home Phone: Cell Phone: Work Phone:
Email Address (Please list the home or work address that you'd prefer to be contacted at):
Occupation: Employer:
Bus Transportation
Is bus transportation needed? YesNo
So that we can assist you with bus transportation, please check the public school district in which the student resides: AshwaubenonDe PereGreen BayHoward-SuamicoPulaskiWest De Pere
Sibling Information
First Name Last Name Date of Birth (Month/Day/Year) Current School Current Grade 1. 2. 3. 4. 5.
Emergency Information
Emergency Contact's Name: Phone:
Hospital Preference:
Does the student have allergies? YesNo
If so, please list:
Does the student have physical disabilities or medical concerns? YesNo
If so, please list: