Divine Redeemer Application for Admission

DIVINE REDEEMER CATHOLIC SCHOOL

APPLICATION FOR ADMISSION

To begin the application process, please return this form with the $60.00 non-refundable application fee and a copy of your child’s most recent report card, standardized test scores, and birth certificate. We will notify you regarding entrance testing/assessment and interviews.

STUDENT INFORMATION

Date:_______

Gender: Male ___ Female ___

Social Security: ____________

Student Name: _________________________________________________________________

(First)

(Middle)

(Last)

Name Called: _________________

**Birth date: ________________

Present Grade: _____

Grade Entering: _____

For school year: ___________

**Students entering K4 must be 4 years of age on or prior to Sept 1st

**Students entering K5 must be 5 years of age on or prior to Sept 1st

PARENT/GUARDIAN INFORMATION

Father's/Guardian's Full Name: _________________________________________________

Mother's Full Name (including maiden) : ________________________________________

Marital Status: Married _____ Separated ______ Divorced ______ Single ______

Father's Religion: _________________

Mother's Religion:___________________

If Catholic, Parish or Church in which registered: _____________________________

Home Phone Number: _____________________

Father's Cellular: __________________

Mother's Cellular: _________________

Street Address: ________________________________________________________________

City: ____________________________

State: ______

Zip Code:______________

Father's/Guardian's Occupation: ________________________________________________

Place of Employment: ____________________________

Work Phone: _________________

Mother's/Guardian's Occupation: ________________________________________________

Place of Employment: ____________________________

Work Phone: _________________

NEW STUDENT HISTORY

Please list ALL schools CURRENTLY and PREVIOUSLY attended and dates of attendance:

Grade

Date

School Name

Address

Telephone

________________________________________________________________________________

Has your child received any of the following services? (Please check if applicable.)

_____ Speech Therapy	_____ Remedial Classes	_____ Occupational Therapy
_____ Physical Therapy	_____ Enrichment Classes	_____ Resource Services
_____ Chapter I Services	_____ Psycho/Educational Evaluation
_____ Other (Please specify)	____________________________________________________

Please describe circumstances for the above checks: ____________________________

________________________________________________________________________________

Has your child repeated any grade?:

___ Yes ___ No

Has your child skipped any grade?:

___ Yes ___ No

Describe the educational ability of your child: ________________________________

________________________________________________________________________________

Describe the personality of your child: _______________________________________

________________________________________________________________________________

Describe the school behavior of your child: ____________________________________

________________________________________________________________________________

Does your child have any physical handicaps/health restrictions?: ___ Yes ___ No

(Please explain:) ______________________________________________________________

________________________________________________________________________________

Referred by: ___________________________________________________________________