Pope John Paul II High School

Application for Admission

Please complete the form below. Mandatory fields marked *

Applicant Information

Application Date: 05/14/08
Applicant to Enter Grade * To Begin Enrollment In (mm/yy)
First Name *
Middle Name
Last Name *
Preferred First Name Date of Birth (mm/dd/yy) *
Social Security No. * Gender * Male Female
Current Street Address * City *
State * Zip *
Parent Email Address Telephone # *
Birth City/State/Country *
Citizenship * Non-USA Citizens (Visa Type)
Religion Church Affiliation

Academic Information

List the following information for each school attended in the past three years:

Current School
Dates of Attendance Telephone #
Address
Previous School
Dates of Attendance Telephone #
Address
Previous School
Dates of Attendance Telephone #
Address

Family Information

Father/Guardian

Title, First and Last Name Relationship
Religion Church Affiliation
Occupation Place of Employment
Business Phone Alternate Phone

Please complete if different from applicant information:

Street Address City
State Zip
Parent Email Address Telephone #

Mother/Guardian

Title, First and Last Name Relationship
Religion Church Affiliation
Occupation Place of Employment
Business Phone Alternate Phone

Please complete if different from applicant information:

Street Address City
State Zip
Parent Email Address Telephone #

Applicant Resides With (choose as many as apply)
1. Mother & Father Mother Only Father Only Guardian(s)
2. Mother & Step-Father Step-Mother & Father Grandparent
3. Other

Admissions Information

How did you first learn about Pope John Paul II High School?
Has the applicant previusly applied to Pope John Paul II High School? *
1. Yes No
2. If yes, when? For what grade?
Did the applicant previously attend Pope John Paul II High School? *
1. Yes No
2. If yes for what grades?
3. Reason for leaving?

Has the applicant ever:

Had any disciplinary action taken on them? * Yes No
Been suspended from school? * Yes No
Been expelled from school? * Yes No
Been asked to withdraw by a school? * Yes No
Been put on probation? * Yes No
If yes to any of the above, please explain:
Are there any concerns that pertain to the applicant? (i.e., diagnosed learning disabilities,
medical, physical or emotional conditions, anything uiring accommodations, etc.) *
1. Yes No
2. If yes, please explain and provide appropriate documentation from a qualified professional:
List any clubs, sports, activities or organizations to which the applicant belongs
within their church, school and local community.

List the name (maiden), relationship and graduation year of any parent or sibling who attends or has attended Pope John Paul II High School.

1. Name Name
2. Relationship Relationship
3. Grad. Year Grad. Year

List your siblings names, grades and current schools.

Name Grade School
Name Grade School
Name Grade School

Additional Information

Please use the space provided to include any additional information you feel necessary.

Application

A non-refundable application fee of $50 has been enclosed.

We hereby authorize Pope John Paul II High School and other sources to obtain information to support this application and will not seek access to confidential recommendation and evaluation before or after the applicant's admission. The undersigned releases every person and institution from any and all liability resulting from or pertaining to the furnishing of records, documents and other information provided to Pope John Paul II High School for that purpose.

Our signature on this application verifies that the information set forth in the application and provided in separate documents is true and correct. We understand that any false, misleading, or inaccurate information, or any missing or omitted information, may be deemed to be reason for Pope John Paul II High School to reject this application or dismiss the student from school if accepted. The applicant and both parents are uired to sign the application.

Applicant Initials * Date
Father/Guardian Initials * Date
Mother/Guardian Initials Date

For office use only:

Payment Received Check #