St. Michael Catholic Secondary School
Application for Year 5 Students
Please return your completed form to your Vice Principal
Personal Information
Name: _______________________________________________________________
Address: ______________________________________________________________
Home Phone: __________________________________________________________
Cell Phone: ____________________________________________________________
Parent/Guardian: _______________________________________________________
Parent Guardian: __________________________________________________________________
Credit Information (Please attach a current Credit Counselling Summary to the application):
Anticipated Credit Total end of June current year: __________
Missing compulsory Credits: _____________________________________________________
Reasons for Returning in Year 5:
Complete requirements for Graduation
Need more than one pre-requisite for post-secondary studies
Improve more than one mark for post-secondary studies
Do a Co-op Placement
Other reason: _______________________________________________
Planning Interview:
Returning to Catholic Secondary School is a very serious decision and to that end, you must attend
an interview with your Vice-Principal, Guidance Counsellor and one of your parents. You will need
to articulate your reasons for returning for a fifth year, and to formalize a solid educational plan
endorsed by everyone at the interview.
Student’s Signature: ___________________________________________________
Parent/Guardian Signature: ____________________________________________________
Vice Principal’s Signature: _____________________________________________
Counsellor’s Signature: ________________________________________________
Date: _______________________________