St. Francis DeSales High School
Application for Admission

1. Gender Male Female Date of Birth
2. Last Name First Middle
3. Street Address
4. City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WYZip
5. Telephone Email Address
6. Current School
7. Current School Phone Number

1. Religious Affiliation
2. If Catholic, indicate Parish of registration
3. List all sacraments received (include year and church):
4. U.S. Citizen Yes No Social Security Number
5. Ethnic Origin
   American Indian African American Asian-Pacific Islander Caucasian Hispanic Multi-Racial

1. Physical or mental conditions, or medications taken which the school should be aware of, etc.
2. Have you recently had a multi-factored evaluation (MFE) done?
   Yes No
3. If yes, date:
4. Do you currently have an IEP or services plan established by an educational team?
   Yes No
5. Do you have any learning difficulties that impact your class work?
   Yes No
6. If yes, please explain.
   

1. List any clubs or organizations to which you belonged during the past two years, including leadership positions.

1. Title Father's Name
2. Street Address City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
3. Home Phone Cell Phone
4. Email Address
5. Father's Employer Father's Job Title
6. Work Phone
7. Father's High School
   (If an alumnus of SFD, please indicate grad. year)
8. College/University
9.  
10. Title Mother's Name
11. Street Address City State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
12. Home Phone Cell Phone
13. Email Address
14. Mother's Employer Mother's Job Title
15. Work Phone
16. Mother's High School
    (If an alumnus of SFD, please indicate grad. year)
17. College/University

1. Father Deceased Mother Deceased Parents Married Parents Separated Parents Divorced
2. If separated, to whom should school correspondence be sent? Father Mother Both
3. Student lives with: Father Mother Both Other
4. If other, please specify
5. Number of children in family
6. Number of children who will be enrolled at SFD next year

Completion of this application and payment of the $200.00 fee indicates your intention to register at St. Francis DeSales High School. Any falsification of information on this application may result in dismissal from St. Francis DeSales High School. Parent's signature below authorizes St. Francis DeSales High School to request and obtain additional records from students's current school.