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Admissions Application

Your first name*

Your last name*

Email*

Your phone number* - -

Full name of prospective student*

First, Middle, and Last Name

Year applying for*

Date of birth*

Birthplace*

including City, State, and Country

Gender*MaleFemale

Applying for grade*

What is your race?*

Has this student ever had an educational evaluation?*YesNo

Please specify the educational evaluation.*

Please bring a copy of any evaluation at the time of your visit to the school.

Has this student ever repeated a grade?*YesNo

What grade has this student repeated?*

Home Information

Address*

City/Town*

Zip Code*

Language(s) spoken at home*

Parish*Basilica of the Immaculate ConceptionBlessed SacramentOther

What Parish does your family attend, if any?

Has your child been baptized in the Catholic Church?*YesNo

Church Name*

City and State*

Year*

Parent/Guardian Information

Full name*

First, Middle, and Last Name

Religion*

Address

if different than the student

Employer*

Position

Work phone - -

Cell phone* - -

Email address

Full name*

First, Middle, and Last Name

Religion*

Address

if different than the student

Employer*

Position

Work phone - -

Cell phone* - -

Email address

Previous Educational Information

Has this student ever attended another school or institution?*YesNo

other than Catholic Academy of Waterbury

Name of school or institution*

Phone* - -

Address*

City/Town, State, and Zip Code

Email address

Number of years attended*

Reason for transfer*

This student has attended another school or institution as well.YesNo

Name of school or institution*

Phone* - -

Address*

City/Town, State, and Zip Code

Email address

Number of years attended*

Reason for transfer*

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How did you hear about Catholic Academy of Waterbury?*

Electronic Signature*

Today's date*

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An Investment in Your Child's Bright Future!

Admissions Application

Home Information

Parent/Guardian Information

Previous Educational Information

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