Clear Form
☐ SY 2020-2021
☐ SY 2021-2022
☐ SY 2022-2023
☐ SY 2023-2024
☐ SY 2024-2025
Program Hours
☐ 7:30a-4:00p

Child

☐ M
☐ F
☐ Immigrant
☐ Refugee
☐ Non-Immigrant
☐ U.S. National (e.g. Samoa etc.)
The Catholic School Department must report to the National Catholic Education Association. Federal and local agencies summary data on the gender and ethnic backgrounds of our students. Therefore, it is required that each person applying for admission to a Catholic school indicate his or her gender and ethnic background on the application form. This information does not affect determination of admission. The ethnic designations are used to indicate a general group to which a person applears to belong, identifies with.
Check all that applies

Parent / Guardian 1

☐ American India
☐ Black
☐ Chinese
☐ Filipino
☐ Hawaiian
☐ Part-Hawaiian
☐ Japanese
☐ Korean
☐ Portuguese
☐ Spn, Cub, Mex, Puerto Rican
☐ Samoan
☐ White
☐ Indo-Chinese
☐ Tongan
☐ Pacific Islander
☐ Other

Parent / Guardian 2

☐ American India
☐ Black
☐ Chinese
☐ Filipino
☐ Hawaiian
☐ Part-Hawaiian
☐ Japanese
☐ Korean
☐ Portuguese
☐ Spn, Cub, Mex, Puerto Rican
☐ Samoan
☐ White
☐ Indo-Chinese
☐ Tongan
☐ Pacific Islander
☐ Other

Background information

☐ Both Parents
☐ Father
☐ Mother
☐ Guardian
☐ Yelp
☐ Google
☐ Friend or Family
☐ Other
Please list every school or child care program that your child has attended
What are your educational goals for your child? How do you see us facilitating these goals?
What role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?
Does your child have any hobbies, sports, or special interests, capabilities or talents?
How do you see your child in their social and emotional development?