Application Form For Assessment (Page 2 of 4) in pdf

Application Form For Assessment Page 2

PLEASE PRINT

Entering Grade _______

Age _______

Gender: Male ____ Female____

Last Name

First Name and (

)

Middle Name

Preferred Name if different

___________________ _________________________

___________________

Street Address__________________________________________________________________

City__________________________________ State_________________ Zip Code____________

Date of Birth ____________________ Place of Birth _________________________________

Primary Family e-mail address ___________________________________________________________

Primary Family Home Phone ___________________________

Contact information including address, email and phone number will be included in our Online Parent Directory which is

only accessible to St. Thomas More Catholic School families. Distribution of this list is prohibited.

Child’s Primary Residence (circle one) Both Mother & Father Mother only

Father only Other (specify)

Father’s Name ____________________________________Email________________________________

Address _____________________________________________________________________________

(If different from student)

Married Divorced Separated Widowed Single (circle one)

Religion/Denomination________________________

Father’s Occupation

Father’s Place of Employment

______________________________________

_____________________________________________________

Business Phone ______________________________ Cell Phone ________________________________

Mother’s Name ______________________________________Email_____________________________

Address ______________________________________________________________________________

(If different from student)

Married Divorced Separated Single Widowed (circle one)

Religion/Denomination _______________________

Mother’s Occupation

Mother’s Place of Employment

_________________________________

______________________________________________________

Business Phone ______________________________ Cell Phone _______________________________

Last School Child Attended

Last or Current Grade

_____________________________________

______________

Does your child have an educational or psychological evaluation? Yes___ No___

Does your child have an IEP or 504 document? Yes___ No___

(If answer is yes to either or both of these questions, copies must be included with your application)

Failure to disclose any information will result in automatic withdrawal of student.

Child’s Religion/Denomination___________________________ St. Thomas More Parishioner? Yes___ No ___

Student’s ethnic group*____________________ Catholic parish or church you attend _____________________

Sibling[s] currently attending St. Thomas More Catholic School (include names and grades)

*This information will be used only for the questionnaires we receive from the Federal Government, State and Diocesan Offices.

Application Form For Assessment Page 2

Related Articles

Related forms

Related Categories