Student Information
Date:    Enrolling as: FreshmanTransfer StudentInternational Student
Enrolling in grade level: Date of Birth:
Name: MaleFemale Last First Middle
Address: Street City State Zip
Home Phone: Student Email Address:
Religion: Parish/Church: [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 Unknown Other
Ethnic Background: AsianBlackCaucasianEastern 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 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 list:
Please provide additional information which may be helpful to a teacher in understanding this student. (Examples include extreme shyness, test anxiety, hearing loss, speech difficulties, special education considerations, etc.)
Father Information
Name: Last First Middle
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: Last First Middle
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: Last First Middle
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:
Doctor's Name: Phone:
Dentist's Name: Phone:
Does the student have allergies? YesNo
If so, please list: