St.Anselm Application 2022-2023

ST.ANSELM SCHOOL

40 Belle Avenue San Anselmo,

CA 94960-2892
(415)454-8667
Application for Grade
School Year
The Following information is required for our files:
Child's Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Telephone
Please enter a valid phone number.
Alternate Telephone
Please enter a valid phone number.
Email Address*
example@example.com
Date & Place for Birth
Ethnic Origin(optional)
Religion
Parish
Upload Photograph

Cancelof
Parent/Guardian
Name

First NameLast Name
Initial
Place of Birth
Citizenship
Occupation
Business Address
Business Telephone
Parent/Guardian
Name

First NameLast Name
Initial
Place of Birth
Citizenship
Occupation
Business Address
Business Telephone
Child
Baptism Date
Church of Baptism, Location
First Communion Date
Church & Location
School Currently Attending
Telephone No.
Please enter a valid phone number.
Is child living with both parents/Guardians?
Has your child ever been referred for psycho-educational assessment?

YesNo
Does your child have an active IEP (Individual Education Program) ?

YesNo
Is your child currently receiving Special Services?

YesNo
Tutoring

YesNo
If yes, Please descibe the services.

In order to help us to know you and your child, please answer the following:
1. Why have you choosen St. Anselm for your child's education?
2. Please share with us a brief description of your child. What adjectives best describe him or her? If you have a recent photograph, please attach it (non-returnable).
3. Please tell us how heard about St. Anselm School?
Application fee : $150 per child

Please follow this link to complete your payment in addition to clicking the Submit button on this form.
VanCo Confirmation #*
Should be Empty:

Parent/Guardian

Parent/Guardian

Child