Application

Please complete the following form to submit an application.

Email to Send Confirmation of Application

Year of Proposed Entrance

Applying for Grade

Applicant's Name

First Name

Middle Name

Last Name

Applicant's Address

Street

City, State

Zip Code

Home Phone Number

Place of Birth

Date of Birth

Gender

Male
Female

Father's Name & Address

First

Middle

Last

Use applicant's address (skip to next section)

Street

City, State

Zip

Father's Occupation

Position

Firm or Institution

Business Phone Number

Mother's Name & Address

First

Middle

Last

Maiden Name

Use applicant's address (skip to next section)

Street

City, State

Zip

Mother's Occupation

Position

Firm or Institution

Business Phone Number

Parents are:

Married
Separated
Divorced
Other

Child lives with:

Both Parents
Mother
Father
Other

Please list name, ages and current school for each sibling.

Applicant's Last School

Name

Address

City, State

Zip

Has your child ever received Special Services? (Resource Help, Remedial Reading, etc.)

Yes
No

If yes, please explain and give dates.

Has your child ever been involved in a Gifted and Talented Program?

Yes
No

If yes, please explain and give dates. Please forward a statement from the school describing the program and admission criteria.

Mother's Religion

Father's Religion

Family's Parish

Name

Denomination

Address

City, State

Zip

Sacraments received by applicant:

Baptism:

Date

Church

City, State

First Communion:

Date

Church

City, State

How did you hear about St. Philomena School?

Is either parent a St. Philomena School graduate?

Yes
No

If so, please list year:

St. Philomena School seeks to draw students from all racial and ethnic groups. How would you describe the applicant? (OPTIONAL)

American Indian or Alaskan Native
Black
White
Asian or Pacific Islander
Hispanic
Multiracial

Upon submission of this application form, you accept and agree to the following conditions:

When this application is submitted, please send us the following:

1. Copies of the applicant's most recent report card and standardized test scores.

2. $45.00 non-refundable application fee.

If this application leads to our child's attendance at St. Philomena School, we agree to adhere to the policies of the school and to pay all tuition expenses in accordance with the payment plan to be agreed upon with the school administration.

(Please read "Admissions" section for details on tuition rates and fees.)

St. Philomena School admits students of any race, color, national and ethnic origin and so administers its educational policies, scholarship programs, athletic and other school-administered programs.