DIOCESE OF MANCHESTER
St. Elizabeth Seton School, Rochester NH
Date
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Month
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Day
Year
Date
School Name
Which Catholic School in the Diocese of Manchester are you applying to?
City/Town
City in which school is located.
Student Information
Female
Male
Home Phone Number
Student Name
Last, First, Middle
Street Address
City/State/Zip
Date of Birth
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Month
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Day
Year
Date
Current Grade
Applying for Grade
Present School Name and Address
Student's Religion
If Catholic, name/town or city of parish
Do you have an educational plan (e.g., IEP, 504) or class modifications ever been recommended for this student?
Yes
No
If yes, please specify
Siblings?
Yes
No
Number of siblings
Name of School Siblings Attend
Name of School Siblings Attend
Name of School Siblings Attend
Student resides with: (please check all that apply)
Father
Mother
Stepmother
Stepfather
Guardian
Other
Student's parents are
Married
Separated
Divorced
Never Married
Widowed
Other (Please specify)
If never married, divorced or separated, who has legal custody or decision-making responsibility of the student?
Father
Mother
Both
Other (please specify)
If never married, divorced or separated, who has physical custody or residential responsibility of the student?
Father
Mother
Both
Other (please specify)
If never married, divorced or separated, who has financial responsibility of the student?
Father
Mother
Both
Other (please specify)
Correspondence should be sent to:
Both parents
Father only
Mother only
Other (please specify)
Name of Parent
Dr.
Mr.
Mrs.
Ms.
Other (please specify)
Name
First, (Maidan), Last
Living
Deceased
Relationship to Student
Home Address
Cell Phone
E-mail
example@example.com
Employer
Title
Business Address
Business Phone
Name of Parent
Dr.
Mr.
Mrs.
Ms.
Other (please specify)
Name
First, (Maidan), Last
Living
Deceased
Relationship to Student
Home Address
Cell Phone
E-mail
example@example.com
Employer
Title
Business Address
Business Phone
Name of Guardian (If applicable)
Dr.
Mr.
Mrs.
Ms.
Other (please specify)
Living
Deceased
Relationship to Student
Home Address
Cell Phone
E-mail
example@example.com
Employer
Title
Business Address
Business Phone
Name of Guardian
Dr.
Mr.
Mrs.
Ms.
Other (please specify)
Name
Living
Deceased
Relationship to Student
Home Address
Cell Phone
E-mail
example@example.com
Employer
Title
Business Address
Business Phone
Signature of Parent
*
Typing full name qualifies as Electronic Signature
Signature of Parent
Signature of Guardian
Signature of Guardian
By checking this box, I certify that all information submitted in the admissions process, including supporting materials, is factually accurate and honestly presented. I understand that if such information is inaccurate or false, the student's admission may be revoked. We certify that we will update this information if it becomes outdated. Please note that a completed application does not guarantee admittance.
The school admits qualified students to its programs and does not discriminate on the basis of sex, race, color, national origin, or ethnic origin, or on the basis of disability, if with reasonable accommodation, the applicant can meet the program requirements. While the school admits students of many different religions to the school, it reserves the right to give preference in admission to Catholics.
(For Office Use Only) Application complete upon receipt of
Birth Certificate
Academic Records (1-8) including standardized test results (2-8)
Application Fee (if applicable)
Other Information
Received by
Date
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Month
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Day
Year
Date
Registration Fee - NEW INDIVIDUAL STUDENT $175 - NEW FAMILY $225
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