Application for Admission | School Year |
Student Name (Last,First, Middle Initial) | |
Address (STREET, CITY, STATE, ZIP) | |
Phone Number | |
Date of Birth | * |
Current Age | |
Gender | Female Male |
Grade Entering | |
Religion | Catholic *Non-Catholic |
Place of Worship | |
U.S. Citizenship | Yes **No If No, please indicate birthplace* |
Race | American Indian/Native Alaskan Asian African American Native Hawaiian/Pacific Islander Caucasin 2 or more Races |
Ethnicity | Hispanic Non-Hispanic |
Parent/Gaudian Information | |
Father/Guardian | Mother/Guardian |
Name (Title, First, Last) | | Name (Title, First, Last) | |
Address | | Address | |
Phone Number | Home Work Cell | Phone Number | Home Work Cell |
Email | | Email | * |
Relationship To Student | | Relationship To Student | |
Employer | | Employer | |
Occupation | | Occupation | |
Religion | Catholic *Non-Catholic | Religion | Catholic *Non-Catholic |
Marital Status | * | Marital Status | * |
If divorced/separated, which parent has custody? Are visitation rights permitted to the Non-Custodial Parent? |
Student lives with | *Mother Father Grandparent Guardian *Other * |
Media Release |
I grant permission to use my child’s image and/or name in print, electronic, or digital format for school publication, publicity, and website. | Select one Yes No |
Sibling Information |
Sibling #1 Name | |
Date of Birth | * |
Age | |
School | |
Sibiling #2 Name | |
Date of Birth | |
Age | |
School | |
Schools Previously Attended |
School Name | |
City | |
State | |
Grade/s | |
Reason for Leaving | |
School Name | |
City | |
State | |
Grade/s | |
Reason for Leaving | |
Medical Information |
Student's Pediatrician | Name Phone |
Student Dentist | Name Phone |
Hospital Preference | Name Phone |
Sacraments |
Has your child received the sacrament of Baptism | Yes No |
Has your child received the sacrament of Reconciliation? | Yes No |
Has your child received the sacrament of Communion? | Yes No |
If you have answered any of the questions above "Yes" please fill out the information below. |
Baptism | Date Church City State |
Reconciliation | Date Church City State |
Communion | Date Church City State |
Special Services *This information is necessary for teachers to plan for your child’s success. Failure to disclose this information may halt an application and/or result in
children being asked to transfer to receive services necessary for them to succeed. |
For students entering Pre-K or K: Has your child received services through Birth to 3? | *Yes *No |
Have you ever been invited to attend a PPT meeting for your child? | Yes *No |
Has your child ever had a/an: 504 Plan IEP? | Yes No If "Yes", please specify |
Home Language Survey |
When your child began to speak, what language did he/she speak? | |
What language do the parents/guardians speak to each other? | |
What language is spoken most often at home? | |
Emergency Contacts (Non-Parent or Non-Guardian) |
Emergency Contact #1 | Emergency Contact #2 |
Name | | Name | |
Daytime Phone | | Daytime Phone | |
Relationship to Student | | Relationship to Student | |
Other Information |
Bus Transportation Requested: (Stratford residents only) | Yes No |
Which public school would your child attend if not St. Mark School? | |
Did a family currently enrolled at St. Mark School recommend our school to you? | |
Would you like more information on how to apply to the Bishop’s Scholarship Fund, a NEW source for tuition assistance? | Yes No |
|
Registration Information |
In order to complete your application, please submit the following along with your completed application. K-8: $150 registration fee per family (Due at time of application) Please send to the school the following to complete the application: Copy of Birth Certificate Copy of Baptismal Certificate Records Release Form (for Grades 1 - Grade 8 ONLY) |
Signatures |
I hereby certify that all of the above information is accurate and that my child and I agree to abide by the policies and procedures St. Mark
School as stated in the school handbook, including the tuition policy. |
Parent/Guardian Date |
Parent/Guardian Date |