Enrollment Application

Please complete the form below. Required fields marked with an asterisk *

Grade Applying To*

Answer required for "Grade Applying To"

Contact Information

Student's First Name*

Answer required for "Student's First Name"

Middle Name*

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Student's Birthdate*

Answer required for "Student's Birthdate"

Home Phone (with Area Code)*

Number Required

Student's Social Security Number*

(Do not include hypens in number)

Answer required for "Student's Social Security Number"

Address

Home Street Address*

Answer required for "Home Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Student's Religion*

Answer required for "Student's Religion"

Church Attending (if applicable)

Answer required for "Church Attending (if applicable)"

Pastor (if applicable)

Answer required for "Pastor (if applicable)"

Describe the Family's Situtation (please check all that apply)*

* If applicable, please submit a copy of the court-mandated parenting plan with the application

Answer required for "Describe the Family's Situtation (please check all that apply)"

Married

Single

Divorced

Deceased

Father has custody*

Mother has custody*

Joint custody*

Guardian has custody*

Student Lives With (please check all that apply)*

Answer required for "Student Lives With (please check all that apply)"

Both parents/guardians

Mother

Father

Mother/Stepfather

Father/Stepmother

Grandparent(2)

Other

Race (optional) - please check all that apply

Answer required for "Race (optional) - please check all that apply"

African

African-American

Asian

Caucasian (White)

Hispanic

Other

Primary Language Spoken at Home*

Answer required for "Primary Language Spoken at Home"

Person(s) Responsible for Tuition Payment*

Answer required for "Person(s) Responsible for Tuition Payment"

Public School District in Which the Family Resides*

Answer required for "Public School District in Which the Family Resides"

Public School Student Would Attend in District*

Answer required for "Public School Student Would Attend in District"

Contact Information of Primary Parent/Guardian

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Relationship to Student*

Answer required for "Relationship to Student"

If "Other," describe relationship to student

Answer required for "If \"Other,\" describe relationship to student"

Primary Email Address*

Answer required for "Primary Email Address"

Cell Phone (with area code)*

Number Required

Home Phone (with area code)

Number Required

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Work Phone (with area code)

Number Required

Employer(s)

Answer required for "Employer(s)"

Position(s)

Answer required for "Position(s)"

Contact Information of Second Parent/Guardian

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Relationship to Student

Answer required for "Relationship to Student"

Mother

Step-mother

Father

Stepfather

Grandmother

Grandfather

Legal Guardian

Other (explain below)

If "Other," describe relationship to student

Answer required for "If \"Other,\" describe relationship to student"

Primary Email Address

Answer required for "Primary Email Address"

Mobile Phone (with area code)

Number Required

Home Phone (with area code)

Number Required

Work Phone (with area code)

Number Required

Employer(s)

Answer required for "Employer(s)"

Position(s)

Answer required for "Position(s)"

Student's Primary Physician*

Answer required for "Student's Primary Physician"

Primary Physician's Phone (with area code)*

Number Required

Student's Dentist*

Answer required for "Student's Dentist"

Dentist's Phone*

Number Required

Hospital where student should be taken if parent or physician is unavailable*

Answer required for "Hospital where student should be taken if parent or physician is unavailable"

Allergies and Other Medical Conditions (check all that apply)*

Answer required for "Allergies and Other Medical Conditions (check all that apply)"

None

Allergies (list below)

Asthma

Diabetes

Epilepsy

Heart Problems

Recurring Illness

Other Medical Concerns (list below)

List Allergies and/or Other Medical Concerns

Answer required for "List Allergies and/or Other Medical Concerns"

Medications to be Taken at School

Answer required for "Medications to be Taken at School"

Name and Phone Number of First Emergency Contact*

Answer required for "Name and Phone Number of First Emergency Contact"

Name and Phone Number of Second Emergency Contact*

Answer required for "Name and Phone Number of Second Emergency Contact"

Describe any Special Educational Needs Student May Have

Answer required for "Describe any Special Educational Needs Student May Have"

Does the Student Have an IEP? *

Answer required for "Does the Student Have an IEP? "

Yes (Please provide a copy of the IEP for our records.)

Briefly indicate why you are seeking to enroll your child at St. Louis Catholic Academy.*

Answer required for "Briefly indicate why you are seeking to enroll your child at St. Louis Catholic Academy."

Statement of Confidentiality
It is the policy of this school that all information received regarding an applicant’s application will be treated with complete confidentiality. Only authorized school personnel have access to such information.

Non Discrimination Policy
St. Louis Catholic Academy will admit students of any race, religion, color, or national and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to our school. This school will not discriminate on the basis of race, religion, color, or national and ethnic origin in admission policies, scholarships, athletic, and other school administered programs.

Completing Admissions Process
Upon receipt of this application, the school will contact your family about completing the admissions process.

Please fix the highlighted areas below before submitting.

Enrollment Application