Mount St. Joseph Academy
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New Student Application Form
New Student Application Form
Student Information
Last Name
(required)
First Name
(required)
Middle Name
(required)
Preferred Name
(required)
Date of Birth
(required)
City of Birth
(required)
State of Birth
(required)
Country of Birth
(required)
Gender
Male
Female
Street Address
(required)
City
(required)
State
(required)
Zip
(required)
Home Telephone
(required)
Father's Cell
(required)
Mother's Cell
(required)
Citizen of the USA?
If not, Country of citizenship
Religion
Roman Cathloic
Protestant
Orthodox Christian
Jewish
Buddhist
Other
Parish / Place of Worship
(required)
Entrance Information
Grade of Entrance
9
10
11
12
Date of Proposed Entrance
(required)
Athletic Interests
Extracurricular Interests
Musical Ability/Instruments
Applicant's Education
Name of Current School
Grade Level
Name of Principal/Head
Telephone
School Address
City
State
Zip
Previous Schools
School 1
Dates Attended
Name of School
Address
Phone
School 2
Dates Attended
Name of School
Address
Phone
Family Information
My Parents Are
Married
Separated
Divorced
Father Deceased
Mother Deceased
Student Lives With
Both Parents
Father
Mother
Stepmother
Stepfather
Other Relation
If divorced, who has legal custody?
Who is financially responsible for applicant
Note: Custodial documentation must be submitted with this application
Parent Information
Father
This relation is an Emergency Contact?
Has legal custody?
Lives with the Child?
Salutation
Last Name
First Name
Home Address
Home Telephone
Email
(valid email required)
Employer
Work Address
Business Phone
Business Fax
MSJ Graduate?
If Yes, Year
Mother
This relation is an Emergency Contact?
Has legal custody?
Lives with the Child?
Last Name
First Name
Home Address
Home Telephone
Email
(valid email required)
Employer
Work Address
Business Phone
Business Fax
MSJ Graduate?
If Yes, Year
Stepparent/Guardian Information
Stepfather/Guardian
This relation is an Emergency Contact?
Has legal custody?
Lives with the Child?
Last Name
First Name
Home Address
Email
(valid email required)
Employer
Work Address
Business Phone
Business Fax
MSJ Graduate?
If Yes, Year
Stepmother/Guardian
This relation is an Emergency Contact?
Has legal custody?
Lives with the Child?
Last Name
First Name
Home Address
Email
(valid email required)
Employer
Work Address
Business Phone
Business Fax
MSJ Graduate?
If Yes, Year
Sibling Information
Brothers (Name, School/Grade)
Sisters (Name, School/Grade)
Relative/Alumni Information
Relatives: List any relatives who now attend Mount St. Joseph Academy
Alumni: List any family Members who graduated from Mount St. Joseph Academy
Special Circumstances
Does the applicant have any physical and/or emotional difficulties?
Yes
No
Does the applicant have a current IEP or 504 Plan?
Yes
No
Has the applicant ever been involved in 1) serious disciplinary action, 2) suspension, and/or 3) dismissal or expulsion from a current or previous school?
Yes
No
If Yes, explain here
Tuition and Financial Aid Information
Tuition Tier
Tier I
Tier II
Tier III
Tuition Responsibility
Both Parents
Father
Mother
Other (specify)
Tuition Responsibility Other
Do you need a Financial Aid application packet?
Yes
No
Student Essay||
Why do you want to attend Mount St. Joseph Academy?
(required)
Parent Essay||
Why do you want your daughter/son to attend Mount St. Joseph Academy?
(required)
The application fee is required at the time the application is submitted. Please consult your application packet for the amount of the fee for the current application year.
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1st Year Schedule
Graduation Requirements
Tuition Rates
Financial Assistance
Shadow Day Request
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July 2010
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2 August:
Boys Basketball Camp (9:00 am)
3 August:
Boys Basketball Camp (9:00 am)
4 August:
Boys Basketball Camp (9:00 am)
5 August:
Boys Basketball Camp (9:00 am)
6 August:
Boys Basketball Camp (9:00 am)
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