Applicant Information

Application Date: August 9, 2007     Applying for Grade Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade for School Year 2007-2008 2008-2009

Applicant's Name   

Birthdate Place of Birth Visa Status N/A Applied For

U.S. Citizen or Permanent Resident Yes No    If no, Country of Citizenship

Student Social Security Number     Sex Male Female

Religion: Catholic Other:    If Catholic, Parish:

Correspondence regarding application should be addressed to (please indicate relation to applicant):

Mr. Mrs. Ms. Dr. Mr. and Mrs. Dr. and Mrs. Mr. and Dr. Relationship to Applicant

  Home Number  

The National Association of Independent Schools requires Holy Spirit Preparatory School to provide statistical
information about the ethnicity of its applicants and enrollees. Please choose one of the following categories to
describe your child’s ethnicity. (optional) 

African-American Latino/Hispanic Asian-American Native American

Caucasian Middle Eastern American Multiracial Other

Has this child previously attended Holy Spirit Preparatory School?    No Yes     If so, which years?
Has this child previously applied to Holy Spirit Preparatory School?   No Yes     If so, which years?

Legal Custody of the Student is with: Mother & Father Mother Father Grandparent(s) Mother & Stepfather Father & Stepmother Other If Other, please let us know your relationship to student:

Student lives with: Both Parents Concurrently Mother Father Moves between Mother & Father Other If Other, please explain:

Parent & Family Information

Father's Name Father's Preferred First Name

Home Address (if different from above)

Home Number Mobile Number Email Address

Occupation Title Employer Business Number

Education Religion US Citizen Yes No

Father's Marital Status: Married Divorced/Single Divorced/Remarried Single Parent Deceased

Mother's Name Mother's Preferred First Name

Home Address (if different from above)

Home Number Mobile Number Email Address

Occupation Title Employer Business Number

Education Religion US Citizen Yes No

Mother's Marital Status: Married Divorced/Single Divorced/Remarried Single Parent Deceased

Please list all schools student has attended, beginning with current school:

Name of School City State

Grades Attended Reason for Leaving

Name of School City State

Grades Attended Reason for Leaving

Name of School City State

Grades Attended Reason for Leaving

Student’s Siblings:

Namet  Age Current School

Namet  Age Current School

Namet  Age Current School

Namet  Age Current School

Namet  Age Current School

Medical Information

Please explain the following items if applicable:

Applicant has a physical disability or challenge or a medical condition for which the school will need to make accommodations.

Applicant has received psycho-educational testing. Please enclose a copy of this report.

Does your child take any medication on a regular basis: No Yes
If yes, please list medication(s), dosage, and times given:

Additional Information

Individual(s) Responsible for Tuition Payments

Mr. Mrs. Ms. Dr. Mr. and Mrs. Dr. and Mrs. Mr. and Dr. Relationship to Applicant

Please check here if you are interested in receiving an application for tuition assistance.

Do you plan to continue your child’s education at Holy Spirit Preparatory School through Grade 12? Yes No

If no, from which school do you anticipate your child graduating Grade 12?
Please tell us how you heard about Holy Spirit Preparatory School:

Statement of Accuracy and Authenticity:
The information in this application is complete and accurate to the best of my knowledge. I will notify Holy Spirit
Preparatory School of any changes before and after enrollment.

Signature of Parent/Guardian Date

Thank you for applying to Holy Spirit Preparatory School.