Editing previous response:

Please fix the highlighted areas below before submitting.

Application to be a new student at SCSS

scss logo

Please complete and submit the form below.

All fields marked with * are required.

Student Information

Legal First Name*

Answer required for "Legal First Name"

Legal Middle Name

Answer required for "Legal Middle Name"

Legal Last Name*

Answer required for "Legal Last Name"

Applying for*

Answer required for "Applying for"

Fall 2023-2024

Option

Grade Entering*

Answer required for "Grade Entering"

Date of Birth*

Answer required for "Date of Birth"

Age*

Numbers Only

Answer required for "Age"

The following information is necessary for teachers to plan for your child's success and to provide an educational experience to suit their learning needs.

If you answered YES for the question above, please provide details below.

Answer required for "If you answered YES for the question above, please provide details below."

If you answered YES for the question above, please explain...

Answer required for "If you answered YES for the question above, please explain... "

(Falsification of Information can result In dismissal from school)

Please list all schools your child has attended since preschool and/or daycare:

Current School Name

Answer required for "Current School Name"

City/State

Answer required for "City/State"

Year Started

Numbers Only

Answer required for "Year Started"

School Name

Answer required for "School Name"

City/State

Answer required for "City/State"

Years Attended

Numbers Only

Answer required for "Years Attended"

School Name

Answer required for "School Name"

City/State

Answer required for "City/State"

Years Attended

Numbers Only

Answer required for "Years Attended"

School Name

Answer required for "School Name"

City/State

Answer required for "City/State"

Years Attended

Answer required for "Years Attended"

What is the name your child likes to be called by friends and family

Answer required for "What is the name your child likes to be called by friends and family"

Activities/hobbies/interests they like outside of school:

Answer required for "Activities/hobbies/interests they like outside of school:"

List a few of your child's academic or other strengths:

Answer required for "List a few of your child's academic or other strengths: "

Do you have any academic or social concerns for you child while attending SCSS?

Answer required for "Do you have any academic or social concerns for you child while attending SCSS? "

FAMILY INFROMATION

Father's Information

Father's Full Name*

Answer required for "Father's Full Name"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Home Phone

Number Required

Cell Phone*

Number Required

Primary Email (used for ALL communication): *

Answer required for "Primary Email (used for ALL communication): "

Name of Employer

Answer required for "Name of Employer"

Occupation/Title:

Answer required for "Occupation/Title:"

Work Phone

Number Required

Work Address:

Street, City/State

Answer required for "Work Address: "

Mother's Information

Mother's Full Name*

Answer required for "Mother's Full Name"

Mother's Maiden Name

Answer required for "Mother's Maiden Name"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Home Phone

Number Required

Cell Phone*

Number Required

Primary Email (used for ALL communication): *

Answer required for "Primary Email (used for ALL communication): "

Name of Employer

Answer required for "Name of Employer"

Occupation/Title:

Answer required for "Occupation/Title:"

Work Phone

Number Required

Work Address

Street, City/State

Answer required for "Work Address"

If you answered OTHER for the question above, please explain...

Answer required for "If you answered OTHER for the question above, please explain... "

If divorced/separated,are there any custody/visitation restrictions? If YES please specify

Answer required for "If divorced/separated,are there any custody/visitation restrictions? If YES please specify"

Sibling's Information

Name

Answer required for "Name"

Date of Birth

Answer required for "Date of Birth"

Name

Answer required for "Name"

Date of Birth

Answer required for "Date of Birth"

Name

Answer required for "Name"

Date of Birth

Answer required for "Date of Birth"

Name

Answer required for "Name"

Date of Birth

Answer required for "Date of Birth"

OTHER

If Catholic, current parish you are supporting: NAME and CITY

Answer required for "If Catholic, current parish you are supporting: NAME and CITY"

If you answered YES for the question above, please list all the people: NAME, RELATIONSHIP & YEARS ATTENDED

Answer required for "If you answered YES for the question above, please list all the people: NAME, RELATIONSHIP & YEARS ATTENDED"

Primary Language(s) spoken at home:*

Answer required for "Primary Language(s) spoken at home:"

Baptismal Date

Answer required for "Baptismal Date"

Church

Answer required for "Church"

City/State

Answer required for "City/State"

New Application Fee*

Answer required for "New Application Fee"

$75.00

Full Name*

Answer required for "Full Name"

Date*

Answer required for "Date"

Please upload a copy of your child's birth certificate*

Answer required for "Please upload a copy of your child's birth certificate"

Choose a file or drag it here.

Please upload a copy of Baptismal Certificate and all other Sacraments received.

Answer required for "Please upload a copy of Baptismal Certificate and all other Sacraments received."

Choose a file or drag it here.

This is only an application to be accepted. Enrollment is not guaranteed.

I hereby certify that all of the above information is accurate, by SUBMITTING the form.

SCSS admits students without regard to race, color, ethnicity, or religion.

190 Shelton Rd Trumbull, CT, 06611 - (203) 375 1947 - [email protected] - w ww.stcatherinesienatrumbull.org

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"