ST. MARY'S                                           611 S.W "A"AVENUE

CATHOLIC                                              LAWTON, OKLAHOMA 73501     

SCHOOL                                               TEL. 580-355-5288 saintmarysknights@juno.com  

 www.stmaryslawtonok.com

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___________________________________________           School Year:__________

Student’s Name (first and last)

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Family Name

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Street Address                                              City                             State               Zip

________________________________________________________________

Mailing Address                                            City                             State               Zip

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Home Telephone Number                                                                email address

Name of Lawton Public School in your neighborhood:______________________

STUDENT INFORMATION

List all other school age children in the family:

FAMILY INFORMATION

Child(ren) live with ____Both Parents ____Father ____Mother ____Other (indicate below)

Do both parents have legal access?____Yes ____No

***CUSTODIAL PARENT IS REQUIRED TO PROVIDE THE SCHOOL A COPY OF ANY CUSTODY AND VISITATION DECREES***

____Father Deceased ____Mother Deceased ____Guardians

____Grandparents ____Ward of the Court

FATHER: ____Married ____Divorced ____Remarried ____ Single

                                                                                                            _          _

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First Name                  Middle              Last Name                                     SSN                     

______________________________________________________________________

Employer                         Occupation                   Work Phone                        email

______________________________________________________________________

Religion                                   Church Attending

MOTHER: ____Married ____Divorced ____Remarried ____ Single

                                                                                                            _          _

______________________________________________________________________

First Name                  Middle              Last Name                                     SSN                     

______________________________________________________________________

Employer                         Occupation                   Work Phone                        email

______________________________________________________________________

Religion                                   Church Attending

PRE-SCHOOL AGE CHILDREN

ETHNIC BACKGROUND

____Asian ____Pacific Islander ____Black/African American ____Hispanic/Latino

____Native American ____White/Caucasian ____Multiracial

St. Mary’s Catholic School does not discriminate in admissions, administration, or instruction of children based on race, color, ethnic origin, religion, or sex. St. Mary’s is required to provide the Oklahoma State Department of Education annual demographic information solely for statistical purposes.

Application Questionnaire

This questionnaire will help us better understand your child and ensure the best educational environment for him/her. St. Mary’s School cannot guarantee that we can meet all special needs such as behavioral and/or academic. Please answer questions for each child applying for admission.

1. Please list all previous evaluations or testing for regular school placement, gifted and talented, home-schooling, special services, Individualized Education Plans (IEP), tutoring, etc. This is to include any educational, psycho-educational, and/or psychological testing. A copy of any such assessments should be provided to St. Mary’s Catholic School.

2. Please list any medical, developmental, and/or psychological problems and treatment (including medications) your child has experienced. Please include diagnosis of ADD/ADHD, Tourette Syndrome, and physical or mental disabilities, etc. Please explain whether these have affected your child’s educational progress and in what ways.

3. Please list and explain any adjustment and/or behavior problems your child has demonstrated. Please also explain recommendations and help received regarding these issues.

4. Please list and describe your child’s strengths and any other comments you wish to make so that we may better understand your child.

5. Please list any food allergies or any other physical limitations that we should be aware of that affect your child.

APPLICATION AGREEMENT

In applying for admissions to St. Mary’s Catholic School I have fully and truthfully answered all questions regarding my child(ren). I further understand that the school’s acceptance of this application and supporting information does not constitute enrollment. I will be notified by the school administration of their admissions decision.

If my child(ren) is/are admitted to St. Mary’s Catholic School I agree to accept the responsibility of supporting the school policies and regulations as defined in the Parent/Student Hnadbook. Please review the current handbook for policies on admission and application processes.

I further agree to honor my financial obligations to the school in a timely manner according to school policies and procedures. Unless indicated below, I certify that I am the person financially responsible for this child’s education.

____________________________________________              _________________

Parent/Guardian Signature                                                                       Date

Financial Responsibility (if other than the custodial parent):

      ______________________________________________________________

      Name

      ______________________________________________________________

      Relationship to the student

      ______________________________________________________________

      Street Address                        City                                  State                   Zip

      _______________________________          ___________________________

      Home Phone                                                   Work Phone