Parent’s First Name*

Parent’s Last Name*

Parent’s Email*

Home Address*

Home Address 2

City*

State* ---PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code*

Home Phone Number

Cell Phone Number

Student’s First Name*

Student’s Last Name*

Student’s Email

Student’s Current School*

Student’s Current Grade* ---7th8th9th10th11th

Parish (if applicable)

Academic Interests (select all that apply) BusinessEnglishFine ArtsHealth & PEMathematicsScienceSocial StudiesTheologyWorld Languages

Activities (select all that apply) Student CouncilNational Honor SocietySociedad Honoaria Hispanica (Spanish Honor Society)Societe Honoraire de Francais (French Honor Society)Mu Alpha Theta (Math Honor Society)Activities RepresentativesMathletesScience ClubWriting ClubAASA (African American Student Association)Asian Culture ClubPolish ClubRALYKairos LeadersCSC (Community Service Corps)SADD (Students Against Destructive Decisions)AmbassadorsRespect Life ClubThe Handmaids of MaryDramaticsStage CrewHallahan Day ShowConcert BandChorusHTV (Television)Sand Script (Newspaper)Silver Sands (Yearbook)Hourglass (Literary Magazine)

Athletics (select all that apply) BasketballBowlingCheerleadingCross CountryGolfSoccerTrack & FieldVolleyball

Best way to reach you?  Email Phone Mail

Best time of day to reach you?  Morning Afternoon Evening

Would you like a school information packet sent home?  No Yes

Would you be interested in making an appointment for a tour?  No Yes