Bishop Canevin High School

Applicant's Name

First Name*

Middle Name*

Last Name*

Gender*

Male

Female

General Information

Nickname

Home Telephone Number*

Birth Date (mm/dd/yyyy)*

Parish/Church*

Catholic or non-Catholic*

Catholic

Non-Catholic

Home Address*

City*

State*

Zip Code*

Public School District*

Present School*

Dates Attended*

Previous School

Dates Attended

Present Grade*

Applying to Grade*

Father/Step-Father/Guardian

Choose One*

Father

Step-Father

Guardian

Name (First, Middle, Last and Suffix)*

Address*

City*

State*

Zip Code*

Home Telephone Number*

Cell Phone Number*

Business Phone Number

E-Mail Address*

Employer*

Position/Occupation*

Business Address

City

State

Zip Code

Father/Step-Father/Guardian is a Canevin Catholic or Bishop Canevin Graduate?*

Yes

If yes, what year?

Mother/Step-Mother/Guardian

Choose One*

Mother

Step-Mother

Guardian

Name (First, Middle, Maiden, Last)*

Address*

City*

State*

Zip Code*

Home Telephone Number*

Cell Phone Number*

Business Phone Number

E-Mail Address*

Employer*

Business Address

City

State

Zip Code

Mother/Step-Mother/Guardian is a Canevin Catholic or Bishop Canevin Graduate?*

Yes

If yes, what year?

Applicant Resides with*

Both Parents

Father

Mother

Step-Father

Step-Mother

Other:

Name of Person(s) Responsible for Paying Tuition*

If parents do not reside together, should both parents receive school mailings? (If yes, please give name and address)

Yes

Name

Address, City, State, Zip Code

The Following Information Is Used to Gather Demographic Information About Our Students For Reporting Purposes.*

American Indian/Native Alaskan

Asian

Black

Native Hawaiian/Pacific Islander

White

Two or More Races

Student Ethnicity*

Hispanic

Non-Hispanic

Brothers & Sisters

Name

Age

Sex

Male

Female

Present Grade

Present School/Occupation

Name

Age

Sex

Male

Female

Present Grade

Present School/Occupation

Name

Age

Sex

Male

Female

Present Grade

Present School/Occupation

Name

Age

Sex

Male

Female

Present Grade

Present School/Occupation

Does your child have an Individualized Instruction Plan (IEP) or a Growth Plan in their current school that would identify a diagnosed Learning Disability?

Yes

I hereby grant Bishop Canevin High School administration permission to request and examine all information provided by my previous school(s) attended in considering my application for acceptance, admittance and course placement, including: Academic Records, Standardized Test Scores, Attendance Record, Conduct/Discipline Record, Health Record, Psychological Record, Principal and/or Teacher Recommendations.*

Yes

Signature of Student*

Date (mm/dd/yyyy)*

Signature of Parent/Guardian*

Date (mm/dd/yyyy)*

Signature of Parent/Guardian*

Date (mm/dd/yyyy)*

Bishop Canevin A Jesuit-inspired High School

Please fix the highlighted areas below before submitting.

Application for Admission 2018-19