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p.1Form #1Application for AdmissionStudent InformationName (First, Middle, Last): ___________________________________________________________________________Email Address: _____________________________________________________________________________________Birth Date (mm/dd/yyyy): ________________ Address: __________________________________________________City: _____________________ State: ___________ Zip: _________________ Country:________________________Primary Contact Person: ____________________________________________ Phone: _________________________Is your child on an IEP or a 504 plan? ____ Yes ____ No Grade applying for: 9 10 11Please list any learning disabilities (Dyslexia, Attention Deficit Disorder, etc.): ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please list any life-threatening medical conditions: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Religion: __________________________________________ Eighth Grade School Name and Address: __________________________________________________________________________________________________________________________________________________________________Have you attended high school: ____ Yes ____ No Number of years attended: _________________________Have you ever been dismissed or expelled from a school for academic or disciplinary reasons? ____Yes ____NoIf yes, please explain on a separate sheet of paper.Are you applying as an international student requiring an I-20 or F-1? ____ Yes ____ Nop.2Family InformationNumber of brothers: ____ Older ____ Younger Number of sisters: ____ Older ____ YoungerFather’s InformationMother’s InformationName:Name:Employer:Employer:Occupation:Occupation:Work Phone:Work Phone:Cell Phone:Cell Phone:Email Address:Email Address:Complete the following ONLY if different from ApplicantFather’s Full Address:Mother’s Full Address:Home Phone:Home Phone:Email Address:Email Address: Form #1 con’d: Application for Admission p.3 To be completed by the ApplicantHow did you hear about Marian High School?Why are you interested in attending Marian High School?Do you plan to attend college?If not, what are your plans after graduating from high school?What careers or occupations do you think you might be interested in?List any significant work experience:List extracurricular activities:List any offices held, awards received, etc.:List any special interests which you feel the Board of Admissions should know:What Marian Activities are you interested in? Please refer to our website at: for a complete listing._______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ p.4Comments:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Personal Essay:On a separate sheet of paper, IN YOUR OWN HANDWRITING, write an essay of approximately 250 words concerning one or more of the following:Why I want to attend Marian High School.What I hope Marian High School can do for me.What I hope to do for Marian High School.The information provided on this application is correct to the best of our knowledge. If accepted by the Board of Admissions, we agree to follow the policies and regulations of Marian High School.________________________________________________ _____________________________________________Signature of Parent(s)Signature of Parent(s)____________________________________________________________________________________________Signature of StudentDatePlease send to:Or email to:Susie Sullivan, Principalssullivan@Marian High School7400 Military AvenueOmaha NE 68134Form #1: Application for Admission ................
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