Thank you for applying to St
Thank you for applying to St. Theresa School! Please fill out one application per child. Complete all sections, indicating “N.A.” if something does not apply. Please print, enclose a $75 application fee and return to the school office.
GRADE APPLYING FOR:________
Child’s Name:
| | | |
last name first name middle name
Address:
| | | | |
number and street name city state zip
|Home Phone: ( ) |Child’s citizenship: ☐ U.S., native-born ☐ U.S., naturalized ☐ Other |
|Gender: ☐M ☐F |Age: |Date of birth: |Place of birth: |
|# of siblings: Age(s): |Grade(s) of sibling(s) currently enrolled at St. Theresa School: |
Child is presently living with:
☐ both natural parents ☐ mother and stepfather ☐ father and stepmother ☐ single parent mother
☐ single parent father ☐ other- please explain
________________________________________________________________________________________________________
If shared custody, please explain custody arrangement:
_________________________________________________________________________________________________
Were you referred to St. Theresa School by one of our current families?
Family name:
_________________________________________________________________________________________________________
How did you hear about St. Theresa School? (Check all that apply.)
☐ Parish bulletin ☐ Friend ☐ Preschool ☐ Newspaper ☐ Website ☐ Other___________________
Father/Guardian: Mother/Guardian:
First Name: __________________________________________ ____________________________________________
Last Name: __________________________________________ ____________________________________________
Address: __________________________________________ ____________________________________________
City, State, Zip: __________________________________________ ____________________________________________
Email Address: __________________________________________ ____________________________________________
Home Phone: __________________________________________ ____________________________________________
Cell Phone: __________________________________________ ____________________________________________
Business Phone: __________________________________________ ____________________________________________
Occupation: __________________________________________ ____________________________________________
Employer: __________________________________________ ____________________________________________
Religion: __________________________________________ ____________________________________________
Baptized: ☐ Roman Catholic ☐ Other ☐ Roman Catholic ☐ Other
Alumni? ☐ Yes__________________(year) ☐ No ☐ Yes__________________(year) ☐ No
US Citizen? ☐ Yes ☐ No ☐ Yes ☐ No
Date Church City, State/Country
Child's Baptism: _________________ ___________________________ ________________________________________
Child's 1 st Eucharist:_________________ ___________________________ ________________________________________
Are your currently registered with a parish? ☐ Yes ☐ No
If yes, which parish _________________________________________________________________________________________
How long? _________________________________________________________________________________________
In which parish organizations do you and your family participate?
_________________________________________________________________________________________________________
Does your child attend Faith Formation Classes? ☐ Yes ☐ No
If yes, which parish _________________________________________________________________________________________
Are you willing to reinforce the values taught at St. Theresa School through religious studies including liturgy participation, student retreats and our Service Learning program? ☐ Yes ☐ No
Please include preschool through current schooling.
School City Grade(s How long?
_________________________________________________________________________________________________________
(currently attending)
_________________________________________________________________________________________________________
(previously attended)
Has your child been retained? ☐ Yes ☐ No If yes, what grade? ____________________________
Has your child ever been identified or tested for special needs? ☐ Yes ☐ No
(If yes, please check box[es) below and attach copies of formal educational assessment, and IEPs if applicable.)
☐ Attention ☐ Auditory ☐ Learning ☐ Speech ☐ Visual ☐ Other
Has your child ever experienced any behavioral or disciplinary issues? ☐ Yes ☐ No (If yes, please explain)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Why are you considering moving your child from his/her current school? (Grades 1-6 only)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Why might St. Theresa School be the right school for your child? Please include aspects of a school you believe are most important and your reasons for choosing St. Theresa School.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
What are your child’s strengths and challenges?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Describe your child’s relationship with his/her peers.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
In what ways have you been involved in or supported your child’s present school?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
For your child’s safety, does he/she have any medical conditions we should be aware of? ☐ Yes ☐ No
If yes please indicate: _________________________________________________________________________________________________________
Is there any other information you’d like to share?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I certify that the enclosed information is correct to the best of my knowledge.
☐ I have attached my child’s most recent report card / progress report.
☐ I have attached my child’s recent standardized test scores. (Grades 2-6 only)
☐ I have enclosed the $75 non-refundable application fee, made payable to “St. Theresa School.”
☐ I have attached a recent photo of my child.
Father/Guardian signature: __________________________________________________________ Date: ___________________
Mother/Guardian signature: __________________________________________________________ Date: ___________________
St. Theresa School does not discriminate on the basis of race, color, national or ethnic origin, age, sex or disability in the admission of students or the administration of educational policies, scholarships and other school-administered programs.
For office use only:
REPORT CARD |TEST SCORES |PARISH STATUS |BIRTH CERTIFICATE |BAPTISMAL CERTIFICATE |STUDENT PHOTO |FEE | |
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Student Application
2017/18 SCHOOL YEAR
STUDENT INFORMATION
FAMILY INFORMATION
ACADEMIC INFORMATION
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4850 Clarewood Drive, Oakland, CA 94618 | 510.547.3146 |
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