Application Form

1Applicant Information

2Parent Information

3Additional Information

Applicant Information
Date*
MM slash DD slash YYYY
Applicant Name*
First Middle Last
Sex*
- Male
- Female
Date of Birth*
Month
Day
Year
Place of Birth*
Application for Grade*
Term Beginning*
Present Grade*
Social Security No.*
Citizenship*
Applicant's Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Has the applicant received the following Sacraments?
Baptism*
- Yes
- No
Baptism Date*
Month
Day
Year
First Communion*
- Yes
- No
First Communion Date*
Month
Day
Year
Parish Information
To what parish do the applicant's parents/guardians belong?*
- St. Agatha
If St. Agatha Parish, how long?*
Your Parish Envelope Number*

Parent Information
Mother's Name*
First Middle Last Maiden Name
Mother's Home Address (ONLY IF DIFFERENT FROM STUDENT)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother's Home Phone*
Mother's Cell Phone*
Mother's Email*
Enter Email Confirm Email
Mother's Place of Employment*
Mother's Work Phone*
Father's Name*
First Middle Last
Father's Home Address (ONLY IF DIFFERENT FROM STUDENT)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Father's Home Phone*
Father's Cell Phone*
Father's Email*
Enter Email Confirm Email
Father's Place of Employment*
Father's Work Phone*
Status of Natural Parents?*
- Married
- Divorced
- Separated
- Single
- Widowed
IF DIVORCED, which parent has custody of student?*
CUSTODY DOCUMENTS MUST BE PROVIDED WITH THIS APPLICATION
- Mother
- Father
- Both
Custody Documents*
Max. file size: 20 MB.
Please list siblings of applicant below:*
Name Age Gender (Male or Female)

Previous Schools
Has student applied to St. Agatha School previously?*
- Yes
- No
What year did student previously apply?*
Please give name(s), address(es) of school(s) that applicant has attended within the past five years and length of time.*
Name of School Address # of Years Attended Grade
Has applicant ever been dismissed from any school? Please explain.*
Languages & Abilities
Which language is spoken at home?*
Which language is spoken by applicant?*
What special abilities does your child have? (i.e. athletic, artistic, musical, academic)*
Has your child completed an assessment/evaluation and/or therapy for the reasons stated below.*
- Yes
- No
Please mark all that apply.*
If yes, please supply copy of documentation. Upload documents.
Max. file size: 20 MB.
When
Month
Day
Year
For Student Receiving Scholarship
Name of parent that registered for scholarship:
Parent Social Security Number*
Student Social Security Number*
I HEREBY SUBMIT MY CHILD'S APPLICATION FOR ADMISSION TO ST. AGATHA CATHOLIC SCHOOL. I UNDERSTAND THAT ANY UNTRUTHFUL RESPONSES WILL AUTOMATICALLY RENDER THIS APPLICATION NULL AND VOID.*
Date*
MM slash DD slash YYYY
Application Fee
I understand that the following must be turned in, along with the $50 application fee.
- Copy of Birth Certificate
- Copy of Baptismal Certificate
- Copy of First Communion Certificate (if applicable)
- Standardized Test Scores (FCAT or similar)
- Latest Report Card
- Copy of Report Card showing promotion to the next grade level
- Health Forms
- Immigration paperwork (if applicable – passport and entry permit)
- Custody documents
- Step Up or FES scholarship award letter (if applicable)
Birth Certificate*
Max. file size: 20 MB.
Baptismal Certificate*
Max. file size: 20 MB.
First Communion Certificate
Max. file size: 20 MB.
Standarized Test Scores (FCAT or similar)
Max. file size: 20 MB.
Latest Report Card
Max. file size: 20 MB.
Health Forms
Max. file size: 20 MB.
Immigration paperwork
Max. file size: 20 MB.
Step Up or FES Scholarship award letter
Max. file size: 20 MB.
How did you learn about our school?*
- Friend
- My child attends St. Agatha CCD Program
- Parish Announcement
- Other
Friend: If your friend presently has a child attending our school, what is the child's name?*

Name	Age	Gender (Male or Female)

Name of School	Address	# of Years Attended	Grade

Applicant Information

Has the applicant received the following Sacraments?

Parish Information

Parent Information

Previous Schools

Languages & Abilities

For Student Receiving Scholarship