APPLICATION FOR ADMISSION 2013-14
CATHEDRAL SCHOOL OF SAINT MARY
910 SAN JACINTO BLVD., AUSTIN, TEXAS 78701
(512) 476-6182 • WWW.SMCSCHOOLAUSTIN.ORG
STUDENT INFORMATION
Please type or print.
Full Name of Applicant ______________________________________________________________________________
Last Name
☐ Male
☐ Female
First
Birthdate
Social Security Number
Middle
Preferred Name
__________
Age as of September 1, 2013
Must be 5 by Sept 1 to enter Kindergarten
_________________________________________________________________________________________________________________________
Street Address
City
State
Zip Code
Years at this Address?
Is this student related to a current or former student of Catholic School of Saint Mary?
☐Yes
☐No
If yes, name of relative(s)
For statistical purposes only, please choose one from each category - Ethnicity and Race. (Categories taken from the US Census)
Ethnicity
☐ Hispanic
☐ Non-Hispanic
Race
☐ American Indian/Native American
☐ Native Hawaiian/Pacific Islander
Which School District does your family reside in?
☐ Asian
☐ White
☐ Austin
☐ Manor
☐ Black/African American
☐ Two or more races
☐ Del Valle
☐ Pflugerville
Student’s religion
☐ Hays
☐ Round Rock
☐ Leander
☐ Other
Languages Spoken at home
Sacraments Information
Baptism
Date
_____/_____/_____
mm
dd
yyyy
Reconciliation
First Eucharist
Confirmation
_____/_____/_____
_____/_____/_____
_____/_____/_____
mm
dd
yyyy
mm
dd
yyyy
mm
dd
yyyy
Parish
City, State
SCHOOL INFORMATION
Student’s previous school name
City
State
Dates/grade attended
Student’s previous school name
City
State
Dates/grade attended
Has student ever been suspended or asked to leave any school? If yes, explain
Are you aware of any special considerations required by your child that may impact his or her ability to participate in all aspects of the
programs offered by the Cathedral School of Saint Mary?
☐ Has a diagnosed learning disability
☐ Has a diagnosed behavior disorder
☐ Has a diagnosis of ADD or ADHD
☐ Has a physical disability
☐ Requires daily medication or services of any kind
☐ Other _________________________
☐Has received psychological counseling
☐ Has received speech or special education services
If the child has a diagnosed disability, are there any accommodations that have been recommended?
______________________________________________________________________________________________________________________________
Please list any medications your child is presently taking.
_________________________________________________________________________________________________________________
PARISHIONER STATUS
☐ Our family is registered at Saint Mary Cathedral and we are requesting the active stewardship rate for tuition. Our parish number is: ____________.
☐ Our family is not registered at Saint Mary Cathedral.
FAMILY INFORMATION
Please list name and ages of applicant’s siblings:
Parents’ Marital status.
Student lives with
☐ Married
☐ Separated
☐ Divorced*
☐ Mother and Father
☐ Mother
☐ Guardian, Relationship _________________________
☐ Father remarried*
☐ Mother remarried*
☐ Father
☐ Other ________________________
*If the student’s parents are divorced or legally separated, a certified copy of the court order or decree must be on file in the school office.
☐ Parents
Mailings should be sent to
☐ Mother
FATHER/GUARDIAN
Please check: ☐ Mr.
☐ Dr.
☐ Father
☐ Guardian, Relationship _____________________
MOTHER/GUARDIAN
☐ Deceased
Please check: ☐ Ms.
Full name
Full name
Preferred name
Preferred name
Address
Address
Home phone
Home phone
Work phone
Work phone
Place of employment
Place of employment
Occupation/title
Occupation/title
Cell/pager
Cell/pager
Email
Email
Religion
Religion
STEPFATHER
☐ Dr.
☐ Deceased
☐ Dr.
☐ Deceased
STEPMOTHER
Please check: ☐ Mr.
☐ Dr.
☐ Deceased
Please check: ☐ Ms.
Full name
Full name
Preferred name
Preferred name
Address
Address
Home phone
Home phone
Work phone
Work phone
Place of employment
Place of employment
Occupation/title
Occupation/title
Cell/pager
Cell/pager
Email
Email
Religion
Religion
List all children in the family, including the applicant, in order of birth:
Name
Sex
Age
Date of Birth
Current Grade
Current School