Date

For School Year

Grade Applying For

Parent or Guardian Contact Email

Applicant's Information

Applicant's First Name

Last Name

Middle Name

Preferred Name

Address

City

State

Zip

Sex
BoyGirl

Date of Birth

Birthplace

Ethnicity (US Government and Accreditation Agency Required Data)
Afro AmericanAsian AmericanCaucasianNative AmericanHispanic/LatinoMiddle East AmericanMulti RacialMulti National

Siblings(s) at St. Andrew's

Other Students Applying to St. Andrew's

Has Applicant Applied to St. Andrew's Prior to This Year?
YesNo

If Yes, What Year?

Father's Information

Father's Name

Father's Address (if different from child)

City

State

Zip

Home Phone

Cell Phone

Work Phone

Email Address

Occupation

Job Title

Employer

Employer Address

City

State

Zip

Mother's Information

Mother's Name

Mother's Address (if different from child)

City

State

Zip

Home Phone

Cell Phone

Work Phone

Email Address

Occupation

Job Title

Employer

Employer Address

City

State

Zip

Stepfather's Name (If Applicable)

Phone

Stepmother's Name (If Applicable)

Phone

With Whom does the child live with (Please check all that apply)
Guardian/OtherFatherMotherBoth ParentsStepfatherStepmotherParents Divorced/SeparatedFather DeceasedMother Deceased

Preferred Mailing Name and Address

Preferred Directory Information:
Phone ListedPhone NOT Listed

Student's Present School

Neighborhood School

Current School Address

City

State

Zip

School Phone

Head Administrator

Schools Attended in the past 3 years

School #1:

Grade

Address

Administrator

School #2:

Grade

Address

Administrator

School #3:

Grade

Address

Administrator

Has the student had a professional, educational, or psychological evaluation?
---YesNo

If yes, when?

Please attach a copy of the most recent report (if Applicable)

In what way, if any, has a member of the applicant's family been previously associated with St. Andrew's?

Were you referred by a current St. Andrew's Family?
YesNo

If yes, List Just one Family

How did you learn About St. Andrew's?

Are you interested in applying for Financial Aid?
---YesNoMaybe

For Students Entering 1st grade or above, please List 2 teacher references

Name #1:

Address:

Phone:

Name #2:

Address:

Phone:

List all Children of family in birth order

Name

Sex

Age

School

Name

Sex

Age

School

Name

Sex

Age

School

Name

Sex

Age

School

Grandparents

1. Grandparent's Name

Address (if different from child)

City

State

Zip

2. Grandparent's Name

Address (if different from child)

City

State

Zip

3. Grandparent's Name

Address (if different from child)

City

State

Zip

Address (if different from child)

City

State

Zip

Signature of Parent(s) or Guardian(s)

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