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Student Application Form

        STUDENT APPLICATION FORM



Name of Student: *

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Address: *

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My child is baptized: *

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If yes what church was your child baptized at?

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Are you currently registered Catholic parishioners: *

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If you answered yes to being Catholic parishioners, please continue:

I am a registered parishioner at the following parish:

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We are involved in the life of the parish, which means that parent and child participate consistently at Sunday Mass and holy days of obligation.

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We contribute regularly to the weekly parish offertory with the offertory envelops we receive each month:

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If you have any questions about this section please contact Fr. Jim Csaszar at 342-1348


Sex: *

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Date of Birth: *

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Place of Birth: *

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Mother's Name: *

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Home Phone: *

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Place of Birth: *

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Address if different from child's:

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Father's Name: *

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Home Phone: *

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Place of Birth: *

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Address if different from child's:

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Child's Siblings and their ages:

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Work Phone:

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Email Address:

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Work Phone:

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Email Address:

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Grade Placement Information:




Please fill out this section for Kindergarten.

Is your child in or starting Kindergarten:

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Did your Child attend Preschool:

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If Yes where and how long:

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If your child had Kindergarten screening done at a school other than St. Rose, please bring a copy to the school or mail a copy to, 119 West Water Street New Lexington, Ohio 43764


Please fill out this section for grades 1st thru 8th.

What grade will your child be in:

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Most Recent Schools Attended:

School

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School

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School

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Please bring a copy of your child's last report card to the school or mail a copy to, 119 West Water Street New Lexington, Ohio 43764

Does your Child have an IEP:

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If Yes please describe:

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Custody Status:

If applicable, a copy of custody papers must be provided for the schools record.



Anti Spam

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Dates:

From: To:

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From: To:

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