New Student/New Sibling Application <div> 2021-2022 School Year </div>

STUDENT INFORMATION

Student First Name REQUIRED Please fill out this field. Please enter valid data.

Student Last Name REQUIRED Please fill out this field. Please enter valid data.

Student Birth Date REQUIRED Please fill out this field. Please enter a date.

Grade Applying For REQUIRED Please fill out this field.

PARENT INFORMATION

Name of Parent Completing Application REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Best Phone Number to Contact REQUIRED Please fill out this field. Please enter a phone number.

Parent/Guardian Name #1 Please enter valid data.

Alumna/Alumnus Yes No

Parent/Guardian Name #2 Please enter valid data.

Alumna/Alumnus Yes No

Is the student immunized? REQUIRED Yes No Please fill out this field.

STUDENT ACADEMIC PROFILE

Does the student have siblings already attending Pope John Paul II Regional Catholic Elementary School? REQUIRED Yes No Please fill out this field.

Please list all previous schools and childcare programs the student has attended.

In the two previous school years, has the student been absent from school more than 10 times? REQUIRED Yes No Please fill out this field.

Has the student been suspended or expelled or removed from a school, childcare service, or other educational program? REQUIRED Yes No Please fill out this field.

Has the student ever been identified as having special leaning/behavioral/emotional needs or have another diagnosis that could affect the student academically? REQUIRED Yes No Please fill out this field.

Has the student received learning support in either reading or math REQUIRED Yes No Please fill out this field.

Does the student have an IEP or 504 plan? REQUIRED Yes No Please fill out this field.

Has the student qualified for Early Intervention or any other special services? REQUIRED Yes No Please fill out this field.

Has your child ever been retained in any grade level or was retention recommended by a previous educational program? REQUIRED Yes No Please fill out this field.

If you answered yes to any of the questions above, please explain below.

I understand and verify that all information on this application and all other accompanying forms is truthful, accurate and complete. I understand and give my permission for my child's previous school, child care, or intermediate unit to be contacted for verification of information or to provide a reference. I understand that submitting this application does not guarantee my child admission to Pope John Paul II Regional Catholic Elementary School.

Electronic Signature Of Parent/Guardian REQUIRED Please fill out this field. Please enter valid data.

New Student/New Sibling Application
2021-2022 School Year

This Application is for the 2021-22 School Year

New Student/New Sibling Application 2021-2022 School Year

New Student/New Sibling Application
2021-2022 School Year