Personal Data Form - St. Catharine Academy

Please complete the form below. Required fields marked with an asterisk *

Student First Name*

Answer Required

Student Last Name*

Answer Required

Date of Birth*

Answer Required

Age*

Answer Required

U.S. Citizen*

Answer Required

Yes

Student's Place of Birth*

Answer Required

Social Security #*

Answer Required

Student E-Mail Address*

Answer Required

Home Phone Number*

Answer Required

Street Address*

Answer Required

Apt. #*

Answer Required

Borough/City*

Answer Required

State*

Answer Required

Zip Code*

Answer Required

Student Cell Phone Number*

Number Required

District Code

Answer Required

Grade entering:*

Answer Required

Elementary/Grammar School:*

Answer Required

Parish/Church*

Answer Required

Language Spoken at Home if other than English

Answer Required

Census Information:

Ethnic Survey: Check One*

Answer Required

American Indian or Alaskan Native

Asian/Pacific Islander

Black, not of Hispanic Origin

Hispanic

White, not of Hispanic Origin

Middle Eastern

Religious Affiliation: Check One*

Answer Required

Roman Catholic Christian

Protestant

Baptist

Lutheran

Jewish

Muslim

Hindu

Other:

Parent/Legal Guardian of Student:

(Who does the Student live with during the School Year?)

Mr. & Mrs. :

Answer Required

- Or -

Mr. :

Answer Required

Ms. :

Answer Required

Relationship to student: *

Answer Required

Parents

Grandparent

Mother only

Father only

Mother/Stepfather

Father/Stepmother

Other/Non Relative Guardian (Explain):

Answer Required

Marital Status:*

Answer Required

Single

Married

Separated

Divorced

Remarried

Widow

Mother/Stepmother Work Phone:*

Answer Required

Mother/Stepmother Employer:*

Answer Required

Mother/Stepmother Email:*

Answer Required

Mother/Stepmother Cell:*

Number Required

Father/Stepfather Work Phone:*

Answer Required

Father/Stepfather Occupation/Employer:*

Answer Required

Father/Stepfather Email:*

Answer Required

Father/Stepfather Cell:*

Number Required

Birth Mother's Full Name (include Maiden Name):

Answer Required

Birth Father's Full Name:

Answer Required

SECOND MAILING ADDRESS: Complete ONLY if parents are separated/divorced and a second mailing is requested for the parent not living with the Student:

Parent First and Last Name:

Answer Required

Home Phone

Number Required

Cell Phone

Number Required

Work Phone

Number Required

Address:

Answer Required

I give permission for my daughter's picture to be used in school news releases, publications, etc.:*

Answer Required

Yes

Date:*

Answer Required

Do you have a relative who attends/graduated from St. Catharine Academy?*

Answer Required

Yes

If Yes, Name/s & Graduation year?

Answer Required

Signatures:

Mother First and Last Name:*

Answer Required

Date:*

Answer Required

Father First and Last Name:*

Answer Required

Date:*

Answer Required

Student First and Last Name:*

Answer Required

Date:*

Answer Required

Please fix the highlighted areas below before submitting.

Personal Data Form - St. Catharine Academy