** This application is not intended for international student applicants. If you are an international student, please contact your agency for application requirements.

Student Information
Date:
   Enrolling as:
Enrolling in grade level: Date of Birth:
Name:
Last First Nickname M.I.
Address:
Street City State Zip
Home Phone (xxx) xxx-xxxx:
Religion: Parish Membership:
Ethnic Background:

Current (or Most Recent) School: Phone:
School Address:
Street City State Zip
Parents' Marital Status:
If marked Divorced is
If marked Separted or Divorced who will be responsible for paying tuition?
Student primarily lives with:
Information should be mailed to:
Has the student been diagnosed with learning disabilities?
If so, please complete and mail in the Special Needs Profile found with additional forms after
submitting this application.
 
Father Information
Name:
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:
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:
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?

So that we can assist you with bus transportation, please check the public school
district in which the student resides:

 
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?
If so, please list:
Does the student have physical disabilities or medical concerns?
If so, please list: