admissions guidelines for 5), middle (6-8) and high...macs high school (cchs or ctkchs). applicants...

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Admissions Guidelines for Elementary (K – 5), Middle (6-8) and High School (9-12) Application Dates and Procedures All information for the application process is online at www.discovermacs.org . Applications for enrollment in the Elementary and Middle Schools will be accepted beginning January 1 Early admissions January 1 through January 31 Spring admissions February 1 through February 29 General admissions March 1 - until all seats are occupied Applications for enrollment in the High Schools will be accepted beginning December 1 Early High School admissions December 1 – January 15 General High School admissions January 16 - until all seats are occupied Placement Screening Entrance testing is administered to all K-8 th applicants. Dates and times will be scheduled by our screening agency upon receiving contact information and approval from MACS. Parents will receive a copy of their child’s testing results. The following placement screening will be administered: Entering Kindergarten to 1 st grade Test of Early Reading Ability (TERA) Test of Early Mathematics Ability (TEMA) Peabody Picture Vocabulary Test (PPVT) Speech and Language Evaluation Entering 2 nd through 8 th grade Woodcock-Johnson Test of Achievement (WJA) For more information and details about the testing process, please contact the Admissions Office at [email protected] or 704.370.3273. Applicants entering 9 th grade will be required to register and take the placement screening test at the school of choice. This test is only available on a specific day in January, additional information and instructions are included in the application packet. Fees There is a $100 non-refundable application fee (due with application) per student. Upon notification of acceptance, each new family is required to pay a non-refundable Registration Fee ($125) per student as enrollment deposit within ten business days. Families starting after the start of the 2018-19 school year must pay these fees before the student’s first day of attendance. School Health Services All students are required by NC General Statute 130A-154 to have appropriate required immunizations in order to attend school (all public and private schools). Students must provide proof of immunization and be in compliance with North Carolina immunization requirements prior to admission into the school. All new students must provide proof of physical examination (completed no more than 12 months prior to the anticipated date of school entry). Parents are responsible for providing these records during the application process.

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Page 1: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Admissions Guidelines for Elementary (K – 5), Middle (6-8) and High School (9-12)

Application Dates and Procedures All information for the application process is online at www.discovermacs.org . Applications for enrollment in the Elementary and Middle Schools will be accepted beginning January 1 Early admissions January 1 through January 31 Spring admissions February 1 through February 29 General admissions March 1 - until all seats are occupied Applications for enrollment in the High Schools will be accepted beginning December 1 Early High School admissions December 1 – January 15

General High School admissions January 16 - until all seats are occupied

Placement Screening Entrance testing is administered to all K-8th applicants. Dates and times will be scheduled by our screening agency upon receiving contact information and approval from MACS. Parents will receive a copy of their child’s testing results.

The following placement screening will be administered: Entering Kindergarten to 1st grade Test of Early Reading Ability (TERA)

Test of Early Mathematics Ability (TEMA) Peabody Picture Vocabulary Test (PPVT) Speech and Language Evaluation

Entering 2nd through 8th grade Woodcock-Johnson Test of Achievement (WJA)

For more information and details about the testing process, please contact the Admissions Office at [email protected] or 704.370.3273. Applicants entering 9th grade will be required to register and take the placement screening test at the school of choice. This test is only available on a specific day in January, additional information and instructions are included in the application packet.

Fees There is a $100 non-refundable application fee (due with application) per student. Upon notification of acceptance, each new family is required to pay a non-refundable Registration Fee ($125) per student as enrollment deposit within ten business days. Families starting after the start of the 2018-19 school year must pay these fees before the student’s first day of attendance.

School Health Services All students are required by NC General Statute 130A-154 to have appropriate required immunizations in order to attend school (all public and private schools). Students must provide proof of immunization and be in compliance with North Carolina immunization requirements prior to admission into the school. All new students must provide proof of physical examination (completed no more than 12 months prior to the anticipated date of school entry). Parents are responsible for providing these records during the application process.

Page 2: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

MACS Priority Placement Priority Placement is given to students according to the following classifications, per admission round:

Siblings of current MACS students who are participating Catholics (apply in December)

Students of current MACS teachers

Participating Catholics of a parish in Mecklenburg County and surrounding areas

Participating Catholics of a parish outside of Mecklenburg County and surrounding areas

Siblings of non-participating Catholics and non-Catholics currently attending a MACS school

Non-participating Catholics and non-Catholics

In all cases involving Catholic students, their pastor must certify (with his signature on the enclosed Parish Participation Voucher) that they are participating Catholics in order to have priority placement and be eligible for the Catholic tuition rate. In order to be eligible for the participating parishioner tuition rate, Catholic families transferring into the Charlotte area may provide a letter from the pastor at their current parish stating that they are participating parishioners.

Additional Considerations Every effort will be made to assign your student to your choice school. In the event that your choice is unavailable, applicants will be contacted and asked to select a second or third choice school. If you do not wish to have a second or third choice school, your child will be placed on a waitlist for your first choice. Waitlists follow the MACS Priority Placement guidelines. All schools in the Diocese of Charlotte admit students of any race, color, sex, religion, national and ethnic origin to all the programs and activities generally accorded or made available to students at these schools.

Page 3: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Mecklenburg Area Catholic Schools 1123 South Church Street Charlotte, NC 28203

Application for Admissions High School

Applying for _ at ___________________________________________________beginning _ grade School Choice month/year entering MACS

Please return application to the MACS office along with the following: (No decision will be made until ALL documents are received)

$100 nonrefundable application fee to initiate admissions process, payable to MACS

Official copy of transcript of grades, standardized test scores, GPA, and class rank (two most recent years of academic history including grades and standardized test results)

Complete Principal’s Evaluation Form / Teacher Recommendation Forms: Math, Science, English and Foreign Language (enclosed)

Proof of Physical Exam and Immunizations (Health Form enclosed)

Completed Parish Participation Voucher (enclosed)

(Out of town applicants) Date of relocation to Charlotte: ____________

Student Information

Full Name ______ ___ Preferred Name _

Permanent Address ___ ___ ________

City State ____Zip ________

Home Telephone _ _Date of Birth ___ _______ Male Female

Has applicant ever attended a Mecklenburg Area Catholic School? yes no If yes, ____________________ year and school

Religion Roman Catholic Parish Registered In _______________ *If a Parish Participation Voucher is not

included with the application, status will City, State _ be non-participating until received

Other Name of Religion ________

How did you hear about MACS?_______________________________________________________________________

Parent Information With whom does the applicant reside? ______________________________________

Father's Name ___ ______________ ______________________________________ Title Last First M.I. Preferred Name

Occupation __ ____ _____Business Telephone __ _

Company Company Address _______ _

Cell Telephone ___________________________ Email Address_____________________________________________

Mother's Name ___ ______________ ______________________________________ Title Last First M.I. Preferred Name

Occupation __ ____ _____Business Telephone __ _

Company Company Address _______ _

Cell Telephone ___________________________ Email Address_____________________________________________

MACS Family ID ________ MACS USE ONLY Check #:______________

Amount:______________

Date:_________________

School Year:____________

To be completed by Parent/Guardian

Page 4: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Siblings Names of other children currently enrolled in a MACS school.

Name School Grade

Name School Grade

School Information

Currently in grade_______ Present School Name________________________________________________________

Name of Principal/Head of School______________________________City, State ______________________________ Grades repeated, if any_____________________________________________________________________________

Has the applicant ever received auxiliary services such as outside tutoring, psychological or educational testing, speech and/or language assistance, or professional counseling? yes no

If yes, explain and please provide copies of any testing results.

______________________________________________________________

Has the applicant been hospitalized for significant medical treatment? yes no

If yes, please describe. _

_

Has a physician ever prescribed any medication for attentional or emotional concerns, or is the applicant presently receiving such medication? yes no

If yes, list medication and possible side effects. ________

_

Is your student currently receiving additional services at school? (i.e. gifted program, speech, language, or learning support) yes no

If yes, list services. ________________________________________________________________________________

________________________________________________________________________________________________

List any other health or learning considerations needed for this child. ________

_

If English is not the primary language spoken at home, what is? ____________ _

Student’s special interests, honors or activities___________________________________________________________

________________________________________________________________________________________________

These statements are true and accurate to the best of my knowledge. I understand that if pertinent information is not included or falsified, that my student’s acceptance could be jeopardized or result in his/her removal from the school in the future. I enclosed a check for the application fee of $100 per student applying for admission to the Mecklenburg Area Catholic Schools.

Signature of Parent ____ __ _______________Date ________

Page 5: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Send this form directly to the high school of your choice. Do not include with application.

High School Placement Test for 9th Grade Applicants

The MACS High School Placement Test is administered each year to all 8th graders who wish to apply for 9th grade to a MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted. The placement test is scheduled for Saturday, January 12, 2019. The test will be from 8:00 am until 11:30 am at Charlotte Catholic High School and Christ the King Catholic High School. There is no scheduled make-up test date.

Students are to arrive at the high school on the day of the testing by 8 am. Please bring two #2 pencils and a simple calculator. Students should bring a sweater or jacket in case the room is cold. Placement test scores and an explanation of the test will be mailed to you in spring 2019. For more information or any questions, please call Charlotte Catholic High School Assistant Principal, Angela Montague at [email protected] or 704-716-2454 or Christ the King Catholic High School Counselor, Lisa Daily at [email protected] or 704-799-4400.

Pre-registration, including $25.00 fee, is required for this test and can be completed by mail or online.

To register online:

CCHS: www.charlottecatholic.org Click on “School Store.” On the left-hand-side menu, select “High SchoolPlacement Test.” Proceed with payment.

CTKCHS: www.ctkchs.org Click on “CTK School Store,” choose the “CTK School” tab, then select “High SchoolPlacement Test.” Proceed with payment.

To register by mail:

Complete the entire form below and mail with $25.00 fee payable to either “Charlotte Catholic High School” or “Christ the King Catholic High School” (address below).

Student Name___________________________________________________________________________ Last First M.I.

School Applied: Charlotte Catholic HS Christ the King HS

DOB_________________ Male Female Home Phone________________________________

Father’s Name_______________________________________ Cell Phone __________________________

Mother’s Name______________________________________ Cell Phone __________________________

Send Mail to: (circle one) Mr./Mrs. or Mr. or Ms. (name)_________________________________________

Address: _____________________________________________________________________________________ Number and Street Name City State Zip Code

E-mail__________________________________________________________________________________

Name of Current School______________________________________ City/State_____________________

Religion: Catholic Name of Parish/City_____________________________________ non-Catholic

Charlotte Catholic High School Attn. Angela Montague 7702 Pineville-Matthews Road Charlotte, NC 28226

Christ the King Catholic High School Attn. Lisa Daily

2011 Crusader Way Huntersville, NC 28078

Page 6: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Student Record Release Request (To be given directly to student’s current school)

To Current Principal/Head of School: As part of the application process, MACS requires unofficial academic records, please forward the below student(s) records to:

MACS Admissions Office 1123 South Church Street Charlotte, NC 28203 Fax: 704-370-3292 Email: [email protected]

Please forward: Current year & Previous year grades and standardized tests results (two most recent years of academic

history requested)

Official transcript School profile Discipline and attendance history Immunization record & Physical Current Student Schedule

Most recent IEP & 504 documentation Psychological evaluation Eligibility documentation Any other pertinent student records

Student has applied to the Mecklenburg Area Catholic Schools for admission to the _______ grade for the __________school year.

Student’s Name:_______________________________________________________________________ Last First M.I.

Home Address:________________________________________________________________________ Street City State Zip

Home Phone:__________________________________________________________________________

School Name:_________________________________________________________________________

School Address:________________________________________________________________________ Street City State Zip

Current School Telephone: Current School Fax:________________________

I,_____________________________________________(parent or guardian), do hereby declare that I am legally responsible for the release of information concerning said student, and I do hereby request and authorize_______________________________________________School to give in writing to Mecklenburg Area Catholic Schools copies of all records, including immunization records, pertaining to said student, upon receipt of this Release Request.

Signed:________________________________________________________Date:__________________ Parent or Guardian

Parent/Guardian: Please complete, sign and deliver to your child’s current school

Page 7: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

High School Admissions Principal Recommendation

Student Name:______________________________________ ______ Grade Applying to:__________

Last First M.I.

Applying to: Charlotte Catholic High School Christ the King Catholic High School_________ Current Principal/Head of School Name: ____________________________ ______________________________ Current School:________________________________________________________________________________ Directions: Please evaluate the candidate in the following areas:

Has this student ever appeared before your Discipline Committee? yes no If yes, please comment below.

____________________________________________________________________________________________

Has this student ever been suspended from your school? yes no Please note, if yes. ________________

____________________________________________________________________________________________

How would you rate this family’s overall support of the school?_________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

How would you rate this student’s academic performance? ____________________________________________ ____________________________________________________________________________________________

Signed:________________________________________________________Date:__________________________ Principal or Head of School

Thank you for the time and effort you have taken in completing this evaluation.

Please return to: MACS Admissions Office 1123 South Church Street Charlotte, NC 28203 Email: [email protected] Fax: 704-370-3292

Parent/Guardian: Please complete student information and submit to your child’s current Principal

Page 8: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

High School Admissions Math Teacher Recommendation

Student Name:______________________________________ ______ Grade Applying to:__________

Last First M.I.

Applying to: Charlotte Catholic High School Christ the King Catholic High School_________ Current Teacher Name: ____________________________ Current School:_______________________________ Directions: Please evaluate the candidate in the following areas by placing a check in the appropriate column.

Excellent Above Average

Average Below Average

Poor

Problem Solving

Grasp of New Concepts

Organizational Ability

Works Independently

Classroom Conduct

Completion and Quality of Homework Assignments

Name of Math Course this student is currently enrolled in:____________________________________________

Title/publisher/grade level of text used:____________________________________________________________

Comments:___________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

_

Signature of Math Teacher: __________________________________________ Date ______________________

Thank you for the time and effort you have taken in completing this evaluation.

Please return to: MACS Admissions Office 1123 South Church Street Charlotte, NC 28203 Email: [email protected] Fax: 704-370-3292

Parent/Guardian: Please complete student information and submit to current teacher

Page 9: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

High School Admissions English Teacher Recommendation

Student Name:______________________________________ ______ Grade Applying to:__________

Last First M.I.

Applying to: Charlotte Catholic High School Christ the King Catholic High School_________ Current Teacher Name: ____________________________ Current School:_______________________________

Directions: Please evaluate the candidate in the following areas by placing a check in the appropriate column.

Excellent Above Average

Average Below Average

Poor

Reading Ability/Reading Comprehension

Written Expression

Spelling

Writes Grammatically Correct Sentences

Verbal Expression

Vocabulary Range

Creativity

Organizational Ability

Works Independently

Classroom Conduct

Completion and Quality of Homework Assignments

Name of English Course this student is currently enrolled in:____________________________________________

Title/publisher/grade level of text used:____________________________________________________________

Comments:___________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

_

Signature of English Teacher: __________________________________________ Date ____________________

Thank you for the time and effort you have taken in completing this evaluation.

Please return to: MACS Admissions Office 1123 South Church Street Charlotte, NC 28203 Email: [email protected] Fax: 704-370-3292

Parent/Guardian: Please complete student information and submit to current teacher

Page 10: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

High School Admissions Science Teacher Recommendation

Student Name:______________________________________ ______ Grade Applying to:__________

Last First M.I.

Applying to: Charlotte Catholic High School Christ the King Catholic High School_________ Current Teacher Name: ____________________________ Current School:_______________________________

Directions: Please evaluate the candidate in the following areas by placing a check in the appropriate column.

Excellent Above Average

Average Below Average

Poor

Reading Comprehension

Written Expression

Problem Solving Ability

Grasp of New Concepts

Organizational Ability

Works Independently

Classroom Conduct

Completion and Quality of Homework Assignments

Name of Science Course this student is currently enrolled in:___________________________________________

Title/publisher/grade level of text used: _

Comments:___________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

_

Signature of Science Teacher: __________________________________________ Date ____________________

Thank you for the time and effort you have taken in completing this evaluation.

Please return to: MACS Admissions Office 1123 South Church Street Charlotte, NC 28203 Email: [email protected] Fax: 704-370-3292

Parent/Guardian: Please complete student information and submit to current teacher

Page 11: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

High School Admissions Foreign Language Teacher

Recommendation

Student Name:______________________________________ ______ Grade Applying to:__________

Last First M.I.

Applying to: Charlotte Catholic High School Christ the King Catholic High School_________ Current Teacher Name: ____________________________ Current School:_______________________________

Directions: Please evaluate the candidate in the following areas by placing a check in the appropriate column.

Excellent Above Average

Average Below Average

Poor

Knowledge of Parts of Speech

Vocabulary Acquisition

Willingness to Speak Targeted Language

Classroom Conduct

Completion and Quality of Homework Assignments

Foreign Language currently enrolled in:

Spanish______________

French_______________

Latin_________________

Other (please identify)___________________

Taken for High School Credit?_____YES______NO

Title/publisher/grade level of text used: _

Comments:___________________________________________________________________________________

____________________________________________________________________________________________

_

Signature of Foreign Teacher: __________________________________________ Date ____________________

Thank you for the time and effort you have taken in completing this evaluation.

Please return to: MACS Admissions Office 1123 South Church Street Charlotte, NC 28203 Email: [email protected] Fax: 704-370-3292

Parent/Guardian: Please complete student information and submit to current teacher

Page 12: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Diocese of Charlotte

Catholic Schools

School Health Services

All students are required by NC General Statute 130A-154 to have the following

immunizations in order to attend school (all public and private schools)

1. DTP/DTaP – 5 doses

Tdap - a booster dose is required for individuals who have not previously

received Tdap and who are entering the 7th grade or by 12 years of age,

whichever comes first.

2. Polio – 4 doses

3. Hib – 2 doses (cannot be administered after age 5)

4. Hepatitis B – 3 doses

5. Varicella – 2 doses

Documentation of disease must be from a physician, nurse practitioner,

or physician’s assistant verifying history of disease, approximate date or

age of infection and a healthcare provider signature.

6. Measles – 2 doses

7. Mumps – 2 doses

8. Rubella – 1 dose

10. Meningococcal conjugate Vaccine (MCV) – 2 doses

One dose is required for individuals entering the 7th grade or by 12

years of age, whichever comes first.

A booster dose is required by 17 years of age or by entering the 12th

grade.

11. Pneumococcal conjugate vaccine (PCV) – 4 doses

No individuals 5 years of age or older is required to receive this

vaccine.

The above requirements are applied for certain age groups and whether or not

immunizations began as an infant. The school nurse reviews these requirements on an

individual basis as each student is enrolled.

Parents must provide the immunization certificate to school. The immunization

certificate may be copied. The original certificate should be retained by the family (and

updated as booster doses are received) throughout the child’s school career extending

through college.

Immunization Certificates presented to school must include:

1. Name of child, birth date, address and names of parent/guardian.

2. Full dates of each immunization dose (month, day, year)

3. Name and address of physician or clinic which administered the immunizations.

4. Certificates are to be signed or stamped by the physician or clinic.

Page 13: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

Revised 10/14

DIOCESE OF CHARLOTTE

STUDENT HEALTH RECORD

SCHOOL GRADE

NAM E(LAST) (FIRST) (MIDDLE) BIRTH DATE SEX

FATHER AND MOTHER (MAIDEN NAME) OR GUARDIAN

ADDRESS CITY/STATE ZIP

RECORD OF IMMUNIZATION (Enter date of EACH dose - Mo/Day/Year)

VACCINE #1 #2 #3 #4 #5

DTP/DTaP

Tdap

POLIO

Hib

MMR HEPATITIS B SERIES

MEASLES #1 #2 #3

MUMPS VARICELLA #1 #2

RUBELLA MCV #1 #2

PCV

STATE LAW REQUIRES MINIMUM DOSES FOR EACH VACCINE (SEE REVERSE)

NOTE: Exemptions from NC State Immunization Law require that a statement must be on file in student’s permanent record. Exemptions must

meet requirements of the law. Medical_______

HEIGHT__________ WEIGHT__________ BP__________LAB REPORT__________

VISUAL ACUITY (R)__________ (L)__________ W/O GLASSES/CONTACTS

HEARING PASS__________ FAIL__________

PHYSICAL EXAM NORMAL ABNORMAL PHYSICIAN’S COMMENTS

NUTRITION

SKIN AND SCALP

ENT

TEETH

EYES

HEART

LUNGS

ABDOMEN

ORTHOPEDIC

NEURO

CHECK BOX PRESENT ABSENT PHYSICIAN’S COMMENTS

EMOTIONAL/MENTAL

BEHAVIOR PROBLEM

PHYSICAL HANDICAP-LIMITS

ACTIVITY

RESTRICTION NEEDED

ENCOURAGE PARTICIPATION

OTHER HANDICAP/DISABILITY:

SEIZURES

ALLERGIES

ON MEDICATION (SPECIFY)

FOLLOW-UP RECOMMENDED

Cleared - I certify that I have examined the above named student and that such exam reveals no condition that

would prevent this student from participating in interscholastic sports or physical education classes.

Not cleared. If student not qualified, list reasons. _____________________________________________________

DATE of EXAM__________ PHYSICIAN’S SIGNATURE________________________________________________________

Physician’s Address

Page 14: Admissions Guidelines for 5), Middle (6-8) and High...MACS high school (CCHS or CTKCHS). Applicants can register for this test before school applications are complete and submitted

PARISH PARTICIPATION VOUCHER

Return to: MACS Business Office 1123 S. Church Street Email: [email protected] Fax: (704) 370-3272 Charlotte, NC 28203

The Mecklenburg Area Catholic Schools (MACS) Parish Subsidy Program provides assistance to qualified participating Catholic parishioners with children attending MACS.

PARTICIPATION POLICY Each family expecting to receive the participating Catholic tuition rate must complete this form, have the pastor’s signature, and return the form to the MACS Business Office. Each family will be a:

New family applicant or current family attending MACS

Registered member of a Mecklenburg Area Catholic Parish

Participating* member of a Mecklenburg Area Catholic Parish

Relocation: families relocating to the Charlotte area may have their current parish complete the form. You will then be classified as ‘Catholic Transfer’ and provided the participating Catholic tuition rate. The status is valid for six months. After six months, a voucher from a Mecklenburg area Catholic parish is required.

*Participation status may vary by parish, and it is verified annually between the MACS Business Office and the respective parish. Unless the status changes, a family does NOT have to submit a MACS Parish Participation Voucher each year. A notification of change will be mailed if necessary, which may require a new voucher submission.

FAMILY INFORMATION (To be completed by the family)

Family Name:

Street Address:

City: State: Zip:

Phone: Email:

Student Name: School:

Student Name: School:

Student Name: School:

Please select one:

Current Family New Family Catholic Transfer (Relocations only) Parent/Guardian Signature: _____________________________________ Date: _____________

PARISH INFORMATION (To be completed by the parish)

Parish Name: Pastor Name:

Parish City: Parish State:

I certify, as pastor of this parish, that the listed parent(s) and student(s) are registered and actively participating parishioners as of this date: _____ /_____/_____. Pastor Signature: _____________________________________________ Date: _____________