Riffel High School Grade 10-12 Application Form

Michael A. Riffel

Catholic High School

Grade 10 - 12 Application Form
Please refer to Program of Studies linked HERE prior to completing this form.
Select school year you are applying for
Is this student registering for the Functional Integrated Program for students with intensive needs?
The latest report card MUST be attached to the application

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Compulsory Subjects
GRADE 10
GRADE 11
GRADE 12
Elective Subjects
GRADE 10
GRADE 11
GRADE 12
Must select one from this block (may be taken in grades 10, 11 or 12)
(R) - Restricted Entry AP - Advanced Placement *Pathway Leading to AP
Michael A. Riffel Catholic High School

Grade 10-12 REGISTRATION INFORMATION
Legal First Name
(as it appears on Birth Certificate)
Legal Middle Name
(as it appears on Birth Certificate)
Legal Last Name
(as it appears on Birth Certificate)
Name Used

First NameLast Name
Gender
Date of Birth
MM/DD/YY
Grade Level
Address:
Please select:
Number
Street Address

P.O. Box #

CityProvince

Postal Code
Home Phone
Format: (000) 000-0000.
Student's Cell Phone
Format: (000) 000-0000.
Previous School (include address if out of Saskatchewan)
Property Tax Support:

Other
If home owner, please indicate property tax support
LEARNING RESOURCE. Has your child had assistance through a learning resource teacher in the past?
Indigenous Self Declaration (voluntary):

An Indigenous person in Canada is a First Nations, a Métis or an Inuit person. First Nations “Registered Status” refers to an individual recognized by the Canadian federal government as being registered under the Indian Act. First Nations “Non-Status” refers to a First Nations person who is not registered under the Indian Act.
Based on the above information, do you self-declare as an Indigenous person?
If yes, please indicate:
Heritage Information

The following information is collected for the Ministry of Education and disclosure is protected under The Local Authority Freedom of Information and Protection of Privacy Act, and all employees of Regina Catholic Schools must adhere to Administrative Application 5400.
Student's Country of Birth

Other
Student's Country of Origin (last country of residence0

Other
Student's Citizenship

Other
First Language Spoken at Home

Other
Second Language Spoken at Home

Other
Student Resident Type
Is one or more parent a Canadian Citizen?
Regina Catholic Schools personnel will contact you to discuss further documentation needed
Is one or more parent a Permanent Resident?
Regina Catholic Schools personnel will contact you to discuss further documentation needed
Date of Arrival in Canada

MonthDayYear
Has your child had assistance from an English as an Additional Language (EAL) teacher in the past?
EAL Students - CFR Level
Parent/Guardian 1 Religion/Spirituality
Parent/Guardian 2 Religion/Spirituality
Student Religion/Spirituality
Parish
Is the student baptized Catholic?
PRIMARY CONTACT INFORMATION
Title
Name

First NameLast Name
Lives with student
Relationship
Home Phone (if different than student)
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Address (if different than student)

Street Address

Street Address Line 2

CityProvince

Postal Code
Mail to
Email
example@example.com
ADDITIONAL PRIMARY CONTACT INFORMATION
Title
Name

First NameLast Name
Lives with student
Relationship
Work Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Home Phone (if different than student)
Format: (000) 000-0000.
Address (if different than student)

Street Address

Street Address Line 2

CityProvince

Postal Code
Mail to
Email
example@example.com
EMERGENCY CONTACT INFORMATION

In the event the school cannot get in touch with a primary contact. (NOTE: This contact information is for someone other than the parents/guardians identified above).
Emergency Contact

First NameLast Name
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Business Phone
Format: (000) 000-0000.
Emergency Contact Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Sibling 1
Attends this school
Sibling 2
Attends this school
Sibling 3
Attends this school
Sibling 4
Attends this school
Student's Name

First NameMiddle NameLast Name
TO BE COMPLETED BY PARENT/GUARDIAN
For new students
Parent/Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

PRIMARY CONTACT INFORMATION

ADDITIONAL PRIMARY CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION