SAINT MICHAEL
SCHOOL
21
Sixth Street
Lowell,
MA 01850
Tel.
(978) 453-9511 Fax (978) 454-4104
Application
for Admission
Date of Application:
_____/_____/_____ Application for: September 20________ Grade:
Applicant Information:
____
Student’s
Last Name First
Name Middle Name
Male:_____________Female:__________________ Nationality:_______________________
____
Street
Address City/Town State Zip
Home # ( ) ___ Primary Language
Spoken at Home:
Current
Age: Date of Birth: Place of Birth:
Religion: Church: City/Town:
Baptized: Yes
No Date: Church: City/Town:
1st
Communion: Yes No
Date: Church: City/Town:
School Information:
Current
School: Telephone
#:
Address: City
/ State / Zip:
Last Grade
Completed: (please
attach a copy of your child’s most recent report card)
Does the
student qualify for special services?
Yes No
If yes,
please explain briefly:
Family Information:
Is your
child in custody of both parents?
Yes No
Student
resides with: □ Both
Parents □ Mother □ Father □ Other
If other, please
provide:
Guardian’s
Name: Relationship to Child:
Please list
any other important information we may need to know:
Father’s Information:
Last Name: First
Name MI
Address: City/Town: State Zip
Home # ( ) Cell # ( )
Place of
Birth: Religion:
Employer: Occupation:
Work # ( ) E-Mail Address:
Mother’s Information:
Mother’s Maiden Name:
Last Name: First
Name MI
Address: City/Town: State Zip
Home # ( ) Cell # ( )
Place of
Birth: Religion:
Employer: Occupation:
Work # ( ) E-Mail Address:
Names and ages of
brothers and sisters:
Name: M /
F Age: Grade:__
Name: M / F Age: Grade:__
Name: M
/ F Age: Grade:__
Alumnae:
Please list
names of relatives who attended Saint Michael School
Name: Relation: Year
Attended:
Name: Relation: Year
Attended:
Date:______/______/______
Parent/Guardian
Signature
------------------------------------------------------------------------------------------------------------------------------
How did you
hear about Saint Michael School? □
Newspaper □ TV / Radio □ Internet □ Family/Friend
□ Church Bulletin □
Catholic Schools Brochure
□ I was referred by