Providence Catholic School Application

Providence Catholic School Admissions Application

Please complete ALL information below. An incomplete application can cause delays in processing

By completing and submitting this application you are agreeing that the information submitted on this application is correct and true to best of your knowledge at the time. You have not knowingly submitted any false or misleading information. You understand that if it is determined that the information submitted is false or misleading, admissions to Providence Catholic School may be denied or revoked.

Name

Applicant's Date of Birth

YYYY

Applicant's City and State of Birth

School Year Applying For

Applying for

Fall Semester

Spring Semester

Grade Level Applying for

Applicant's Home Address

With whom does the applicant reside?

Applicant's Home Phone

Applicant's Cell Phone

Applicant's Email

What school are you currently attending?

Name of school

Address, City, State, Zip of School

Phone number of current school

Fax number of current school

Which public school would you normally attend?

Name of school

In what school district does this school reside?

Has applicant ever skipped or repeated a grade?

Yes

If yes please explain

Has the applicant received special accommodations (IEP) or 504?

Yes

If yes please explain

Has the applicant ever been dismissed, suspended or denied readmission from any school for any reason?

Yes

If yes please explain

Has the applicant ever been in the care of a psychiatrist or psychologist?

Yes

If yes please explain

If Catholic to what parish do you belong?

Why do you want to attend Providence?(TO BE COMPLETED BY THE APPLICANT ONLY)

If applying for High School have you taken the High School Placement Test?

Yes

If yes where and when did you take it?

If applying for Middle School have you taken the Middle School Placement Test?

Yes

If yes where and when did you take it?

List any school or community activities, clubs, sports, or extra-curricular activities in which you have been involved

If applying for High School please check the extracurricular activities you are interested in

Check all that apply

Athletics

Band

Choral

Dance

Drama

JROTC

Literary

Visual Arts

Other

If athletics selected please advise which sports you are interested in

If other selected please explain

If applying for Middle School please check the extracurricular activities you are interested in

Check all that apply

Athletics

Choral

Dance

Drama

Visual Arts

Other

If athletics selected please advise which sports you are interested in

If other selected please explain

List any relatives attending or who have attended Providence (list name/s and relationships/s

Applicant's T-shirt size

Youth Small

Youth Medium

Youth Large

Small

Medium

Large

X-Large

Parent/Guardian 1 Name

The next 8 questions pertain to Parent/Guardian 1

Address

HomPhone

Cell Phone

Work Phone

Fax Phone

Place of employment

Job Title

Parent/Guardian 2 Name

The next 8 questions pertain to Parent/Guardian 2

Address

Home Phone

Cell Phone

Work Phone

Fax Phone

Place of employment

Job Title

Best email address for the family

To whom should correspondence and billing information be sent and their address if different from above

How did you hear about Providence?

Did an individual refer you?

Include Name:

Applicant's Digital signature

Sign with mouse. Digital Signatures are legal and binding.

Date

YYYY

Parent/Guardian Digital signature

Sign with mouse. Digital signatures are legal and binding.

Date

YYYY

Promo Code: