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Application for Program Admission

For the 2012 - 2013 school year, you may either complete the online application below or click here to download. Please complete one application per student (so if you have multiple students, each student needs a form completed for their files).

Application for Program Admission

Student Last Name
Student First Name
Student M.I.

Date of Birth
Gender M/F
Applying for grade

Parent/Guardian Name

Address

City
State
Zip

Home Phone
Cell Phone
Email

Occupation
Employer
Work Phone

Parent/Guardian Name (2)

Address (if different from above)

City (2)
State (2)
Zip (2)

Home Phone (2)
Cell Phone (2)
Email (2)

Occupation (2)
Employer (2)
Work Phone (2)

If two addresses, which is the child’s primary household?
At which parish are you a registered member?

Do you live in parish boundaries?
If NO, in which parish do you live?

Sibling Name (1)
Age (1)
School (1)

Sibling Name (2)
Age (2)
School (2)

Sibling Name (3)
Age (3)
School (3)

Sibling Name (4)
Age (4)
School (4)

Campus Selection:

Annunciation Campus (6th-8th grades only)

Please rank the following options for campus enrollment. 1 = first choice, 2 = second choice or indicate that you have no campus preference.
I request enrollment for my child at:

Our Lady of Providence Campus (K-5th grades only)

St. Michael the Archangel Campus (K-5th grades only)

No Campus Preference (K-5th grades only)

For future planning reasons, please outline your reason for your selection:

If the projected grade level homeroom enrollment at my campus choice exceeds the recommended number of students, I would be open to reconsidering my request.
If decisions need to be made about student enrollment, they will be made by the president of Holy Cross Academy in close collaboration with the pastors of all parishes.