Student Information
First Name:	*
Last Name:	*
Preferred Name
Date of Birth:	*
Sex
Address:	*
City:	*
State:	*
Zip Code:	*
Home Phone Number	*
Family Information
Student Lives with:
	Both Parents Father Mother Other
Father's Name
Father's Address
Father's City State Zip Code
Place of Employment
Phone Numbers:
Email Address:
Mother's Name	*
Mother's Address	*
Mother's City State Zip Code	*
Phone Numbers:
Place of Employment
Email Address
Legal Guardian if other
Current School
Child's Interests
Siblings Names and ages:
School History
Present School
Phone
Mailing Address
State/zip code
Name of Current Teacher
Dates Attended
2. Previous School
Phone
Mailing Address
State/zip code
Input field
Personal History
Has the applicant ever been enrolled in any special tutorial classes programs or activities to address social physical or academic challenges?
Has the applicant ever been tested for or diagnosed with:
	Autism ADHD Obsessive Compulsive Disorder Other None
Has the applicant had educaitonal testing for any learning differences or disabilities?
Please explain your reason for selecting Holy Apostles Episcopal School for this student and your goals for this student while at Holy Apostles Episcopal School.
Security code:	*

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