Application New Students 1 Parent Information2 Student Information Father Name First Last OccupationFather Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email PhoneMother Name First Last OccupationMother Address Same as Father's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email PhoneMarital StatusMarriedSeparatedDivorcedFather DeceasedMother DeceasedDivorce DecreeIf parents are divorced, please attach a copy of the divorce decree relating to custody, financial responsibility & release of information.Hispanic or Latino*YesNoEthnicity*Please select the racial category or categories with which you most closely identify. Check as many as apply. American Indian or Alaska Native Asian Black or African Americn Native Hawaiian or Other Pacific Islander White Parish Now Registered*St. BenedictOtherNon-CatholicParish Name*Please enter the name of the parish you currently registered with.Register at St. Benedict?*Do you intend to register at St. Benedict Parish?YesNo No. of Children*Please select the number of children entering St. Benedict School.1234Student Name* First Middle Last Grade*PSPKK12345678Date of Birth* Date Format: MM slash DD slash YYYY Gender*FemaleMalePreschool Options*Please check one.M-F AMM/W/F AMT/Th AMM-F All DayM/W/F All DayT/Th All DayPre-K Options*Please check one.M-F AM & PMM-F AM & M/W/F PMM-F AM & T/Th PMM-F PM OnlyBaptism Date Date Format: MM slash DD slash YYYY ChurchCity/StateFirst Communion Date Date Format: MM slash DD slash YYYY ChurchCity/StateStudent SupportDoes student have or receive ... 504 Individual Education Plan (IEP) Special Education Speech Student Name* First Middle Last Grade*PSPKK12345678Date of Birth* Date Format: MM slash DD slash YYYY Gender*FemaleMalePreschool Options*Please check one.M-F AMM/W/F AMT/Th AMM-F All DayM/W/F All DayT/Th All DayPre-K Options*Please check one.M-F AM & PMM-F AM & M/W/F PMM-F AM & T/Th PMM-F PM OnlyBaptism Date Date Format: MM slash DD slash YYYY ChurchCity/StateFirst Communion Date Date Format: MM slash DD slash YYYY ChurchCity/StateStudent Support*Does student have or receive ... 504 Individual Education Plan (IEP) Special Education Speech Student Name* First Middle Last Grade*PSPKK12345678Date of Birth* Date Format: MM slash DD slash YYYY Gender*FemaleMalePreschool Options*Please check one.M-F AMM/W/F AMT/Th AMM-F All DayM/W/F All DayT/Th All DayPre-K Options*Please check one.M-F AM & PMM-F AM & M/W/F PMM-F AM & T/Th PMM-F PM OnlyBaptism Date Date Format: MM slash DD slash YYYY ChurchCity/StateFirst Communion Date Date Format: MM slash DD slash YYYY ChurchCity/StateStudent Support*Does student have or receive ... 504 Individual Education Plan (IEP) Special Education Speech Student Name* First Middle Last Grade*PSPKK12345678Date of Birth* Date Format: MM slash DD slash YYYY Gender*FemaleMalePreschool Options*Please check one.M-F AMM/W/F AMT/Th AMM-F All DayM/W/F All DayT/Th All DayPre-K Options*Please check one.M-F AM & PMM-F AM & M/W/F PMM-F AM & T/Th PMM-F PM OnlyBaptism Date Date Format: MM slash DD slash YYYY ChurchCity/StateFirst Communion Date Date Format: MM slash DD slash YYYY ChurchCity/StateStudent Support*Does student have or receive ... 504 Individual Education Plan (IEP) Special Education Speech Student(s) Lives With*Both ParentsFather OnlyMother OnlyFather - StepmotherMother - StepfatherGrandparentsLegal GuardianOtherGrandparent/Guardian/Other Name* First Last Student Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Previous SchoolsHow many previous schools do you need to enter?1234Previous SchoolPrevious School Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Previous SchoolPrevious School Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Previous SchoolPrevious School Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Previous SchoolPrevious School Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code