Flll Form

Application Form

Student Information:
Student’s Name: Grade Entering:
  Last Name First Name Middle Initial  
Student's Social Security Number (last 4 digits): Student's Date of Birth: / /
  Place of Birth:
Student's Street Address: Home Phone Number: ( ) - -
  Primary language spoken in home
City State Zip  

Last School Attended:
Name of last school: Phone #: ( ) - -
Address: Dates attended:
  Grade when leaving this school:
  City State Zip    
Reason for leaving current school?
Does your child have special learning needs? 
 
If yes, Please explain:
Does your child have an IEP or Service Plan?
 
If yes, Please explain:
How did you hear about us?

Did you attend St. Augustine School for one (1) or more years?
 
Did you graduate from St. Augustine School?
 
If yes, what year?
 

Parent or Guardian Information:

Father’s Name: Home Phone: ( ) - -
  Last Name First Name Middle Initial Work Phone: ( ) - -
Home Address: Cell Number: ( ) - -
   
  City State Zip
Email:

Education: 

 Occupation:  
Employer:  
Mother’s Name: Home Phone: ( ) - -
  Last Name First Name Middle Initial Work Phone: ( ) - -
Home Address: Cell Number: ( ) - -
   
  City State Zip
Email:

Education: 

 Occupation:  
Employer:  
Guardian’s Name: Home Phone: ( ) - -
  Last Name First Name Middle Initial Work Phone: ( ) - -
Home Address: Cell Number: ( ) - -
   
  City State Zip
Email:

Education: 

 Occupation:  
Employer:  

Please list Brothers & Sisters enrolled at St. Augustine Catholic School:          

Name:
   Date of Birth: / / Grade:
Name:
   Date of Birth: / / Grade:
Name:
   Date of Birth: / / Grade:
Name:
   Date of Birth: / / Grade:
Parent’s/Guardian’s Signature   / /  
Date