Application 2019-2020

Application 2019-2020
Student Information
Student's Name:

First NameMiddle NameLast Name
Gender

MaleFemale
Age
Religion
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Place
Birth Date
PLEASE CHECK ALL THAT APPLY: THIS INFORMATION IS CONFIDENTIAL.
Student Lives with
IF CHILD IS NOT LIVING WITH PARENT(S), PLEASE SPECIFY BELOW
Legal Guardian

First NameLast Name
Relationship to child
Home Address of Legal Guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Address of Legal Guardian

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Work Phone Number

Area CodePhone Number
Ethnic Background
Other
Language Spoken at Home
Other
Student’s Spoken Language(s)
Other
Student’s Citizenship:

U.S. CitizenNon-U.S. Citizen (specify country of citizenship):Other
Student Visa

YesNo
Sibling's Information
Sibling Name 1

First NameLast Name
Date of Birth
Sibling Name 2

First NameLast Name
Date of Birth
Sibling Name 3

First NameLast Name
Date of Birth
SCHOOLS: List school(s) previously attended, include preschool and kindergarten as well as elementary
School Name 1
School Address
Street,City,Zip,Phone
Grade(s)
School Name 2
School Address
Street,City,Zip,Phone
Grade(s)
School Name 3
School Address
Street,City,Zip,Phone
Grade(s)
Has student received educational/behavioral assessment?

YesNo
Explain and Provide copy of report
Has student been retained?

YesNo
If Yes, What Grade(s)
Has student skipped a grade?

YesNo
If Yes, What Grade(s)
Student’s special health concerns
Reason for applying to Holy Cross School?
Neighborhood Public School
Parent Information
Parent Information
Name

First NameLast Name
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number

Area CodePhone Number
Occupation
Birth Place
US Citizen

YesNo
Religion
Parent Information
Name

First NameLast Name
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone Number

Area CodePhone Number
Occupation
Birth Place
US Citizen

YesNo
Religion
WHO WILL BE RESPONSIBLE FOR TUITION PAYMENT?
Record Of Sacraments
baptism date

MonthDayYear
Date
baptism church
baptism city, state
First Reconciliation Date

MonthDayYear
Date
First Reconciliation Church
first reconciliation City,State
First Eucharist Date

MonthDayYear
Date
First Eucharist Church
Name of parish, church, or temple currently attending
City
Registered?

YesNo
Other Family Members Who Attend/ Have Attended Holy Cross School:
Name 1
Year of Graduation
Name 2
Year of Graduation
Name 3
Year of Graduation
How Did You Learn About Holy Cross School? (check all that apply)

Newspaper AdvertisementPosted FlyerWeb siteFacebook pageParish BulletinWord of mouthDriving through areaAlumni referralCurrent family referralOther
Posted Flyer Location
Name of referring Alumni
Name of referring Family
Parent's Email
example@example.com
Date
Should be Empty:

Application 2019-2020

Student Information

Sibling's Information

Parent Information