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PROGRAM REQUEST

What program are you interested in?*

Desired Entry Year*

Desired Entry Grade*

Name*

First Last

Preferred Name

Student's Birthday*

Student's Religion*

If "Other" for Religion - Name of Religion

Current School*

City & State of Current School*

City State / Province / Region Country

Athletics

Check all that apply.

Clubs

Check all that apply.

Parent 1 / Guardian Salutation*

Parent 1 / Guardian Name*

First Last

Parent 1 / Guardian Relationship to Student*

Parent 1 / Guardian Mobile Phone*

Parent 1 / Guardian Mobile Phone Intl*

Parent 1 / Guardian Email*

Parent 2 / Guardian Salutation

Parent 2 / Guardian Name

First Last

Parent 2 / Guardian Relationship to Student*

Parent 2 / Guardian Mobile Phone

Parent 2 / Guardian Mobile Phone Intl

Parent 2 / Guardian Email

Permanent Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your primary reason for applying to Saint Stanislaus?

How did you learn about Saint Stanislaus

If "Other" - Please Define

Phone