St. Charles Preparatory School

Online Admissions Application

St. Charles now provides the ability to submit your admissions application online.

Student Information:

*Student's First Name:

*Student's Middle Name:

*Student's Last Name:

*Student's Social Security Number:

- -

*Student's Date of Birth:

/ /
(enter month/day/year, for example: 09/04/1990)

Student's Place of Birth:

City:

State:

County:

Student's Local Address:

*Street Number:

*Street:

*City:

*State:

*Zip:

*County:

*Home Phone Number:

( ) - -

Student's Permanent Address: (if same as local please leave blank)

Street Number:

Street:

City:

State:

Zip:

County:

Permanent Address Phone Number:

( ) - -

Student's Parish Information:

Home Parish Name:

Home Parish City:

Home Parish State:

Home Parish Zip:

Student's Parish of Baptism:

Parish Name:

Parish City:

Parish State:

Parish Zip:

Student's Religious Affiliation:

Are You Affiliated With A Church Other Than The Roman Catholic:

Yes

Student's Previous Education:

	School Name:	School Address:	School State:	School Zip:	Grade:	Attended From (mm/yyyy):	Attended To (mm/yyyy):
Present School:
Other Schools:
Other Schools:

Father's Information:

*Father's First Name:
Father's Middle Name:
Father's Last Name:
*Father's Social Security Number:	- -
*Date of Birth:	/ / (enter month/day/year, for example: 09/04/1990)
Father's Religion:
Father's Occupation:
Father's Status:	Living Deceased
Address:
Street:
City:
State:
Zip:
County:
Home Phone Number:	( ) - -
Work Phone Number:	( ) - -
Email Address:

Mother's Information:

*Mother's First Name:
Mother's Middle Name:
Mother's Last Name:
*Mother's Social Security Number:	- -
*Date of Birth:	/ / (enter month/day/year, for example: 09/04/1990)
Mother's Religion:
Mother's Occupation:
Mother's Status:	Living Deceased
Address:
Street:
City:
State:
Zip:
County:
Home Phone Number:	( ) - -
Work Phone Number:	( ) - -
Email Address:

Other Information

Has Either Parent Remarried? Give Details:

Sibling Information: (Please list the names of living brothers and sisters)

	First Name:	Last Name:	Birthday:	Address:	Occupation:
1:
2:
3:
4:
5:

Family Information:

(Please list the names of any of your relatives who attended St.Charles and provide the following information:)

	Name	Position:	Relationship:
1:
2:
3:
4:
5:
6:

Financial Aid:

(Please complete the following:)

Are you requsting financial aid?:

Yes
No

If yes, specify any circumstances that the school should be aware of:

*Security Code:

*Required fields