School Headlines

APPLICATION FOR ADMISSION

Author: John LaMattina/Thursday, July 13, 2017/Categories: Headlines

Application for Admission 2017-2018

Northern Chautauqua Catholic School

336 Washington Avenue, Dunkirk, New York 14048

(716) 366-0630

Website: www.nccschool.us

 

PLEASE PRINT ALL INFORMATION

 

Entering Grade: __________

 

Student’s Legal Name: ______________________________________________________________________________________

Last First Full Middle Suffix

 

Address: ___________________________________________________________________________________________________

No. Street PO Box # City/Town Zip

 

Telephone: _____________________________ Birth Date: ________________ School District: ___________________________

 

Birth Place: ______________________________________________ Date Entered United States: _________________________

City State (if applicable)

 

Religion: _______________________________________ Parish Affiliation: _________________________________________

 

Present School: __________________________________ Student Nickname: ________________________________________

 

Guardian(s): ____________________________________________ E-Mail: ____________________________________________

 

Guardian Address: __________________________________________________________________________________________

No. Street PO Box# City/Town Zip

 

Telephone: ____________________________________________ Cell Phone: __________________________________________

 

Father’s Name: _____________________________________________________________________________________________

Last First Full Middle Suffix

 

Father’s Address: ___________________________________________________________________________________________

(if different from student) No. Street PO Box# City/Town Zip

 

Father’s E-Mail: ____________________________________________ Cell Phone: ______________________________________

 

Father’s Occupation: ________________________________________ Title/Position: ___________________________________

 

Name of Employer: _________________________________________ Business Phone: _________________________________

 

Father: Married: __________ Divorced: __________ Single: __________ Remarried: __________

 

Mother’s Name: ____________________________________________________________________________________________

Last First Full Middle Suffix

 

Mother’s Address: __________________________________________________________________________________________

(if different from student) No. Street PO Box# City/Town Zip

 

Mother’s E-Mail: ____________________________________________ Cell Phone: _____________________________________

 

Mother’s Occupation: ________________________________________ Title/Position: __________________________________

 

Name of Employer: __________________________________________ Business Phone: ________________________________

 

Mother: Married:__________ Divorced:__________ Single:__________ Remarried:__________

 

**Please complete both sides of form**

Page 2 - Application for Admission

 

 

Student resides with: Both Parents: ___________ Mother: ___________ Father: _____________ Guardian: _______________

** A copy of the custody agreement must be provided to the school. **

 

Student Ethnicity: Caucasian ___ Black ___ Hispanic ___ Asian ___ Alaskan ___ Multiracial ___ American Indian ___

 

Sibling(s):

 

_____________________________________________________ ____________________________________________________

Name Age Name Age

 

_____________________________________________________ ____________________________________________________

Name Age Name Age

 

Emergency Contacts:

 

Name: _________________________________________________ Relationship to Student:____________________

 

Home Phone: ___________________ Cell Phone: ___________________ Business Phone:____________________

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Name: ________________________________________________ Relationship to Student:_____________________

 

Home Phone: ____________________ Cell Phone: _____________________ Business Phone: __________________

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Name: ________________________________________________ Relationship to Student: ____________________

 

Home Phone: ____________________ Cell Phone: ____________________ Business Phone: __________________

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Name: ________________________________________________ Relationship to Student: ____________________

 

Home Phone: ____________________ Cell Phone: ____________________ Business Phone: ___________________

Sacraments:

 

Baptism: ___________________ _______________________________________________________________________________

Date Church Name City/Town

 

First Reconciliation: ___________________ ____________________________________________________________________

Date Church Name City/Town

 

First Eucharist: ___________________ _________________________________________________________________________

Date Church Name City/Town

 

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