SACRED HEART SCHOOL 701 Franklin Street, West Reading, PA 19611 610-373-3316

SACRED HEART SCHOOL

701 Franklin Street • West Reading, PA 19611
ADMISSIONS APPLICATION
Date of Application *

Month Day Year
Date
Catholic *
PARISH WHICH YOU ARE REGISTERED *
Non-Catholic/Religion
Student Information
Entering Grade *
Grade as of date: *

Month Day Year
Sex *
Date of Birth (mm-dd-yyyy) *

Month Day Year
Date
Place of Birth (country/city/state) *
Last Name *
First Name *
Middle Name
Street Address *
City *
State *
Zip Code *
Home phone number *
Ethnic Background
Transportation *
Public School District of Residence *
Student Information - (2nd child) please complete a full admission application for each child.
student

First Name Last Name
Grade
Sex
Student Information - (3rd child) please complete a full admission application for each child
student

First Name Last Name
Grade
Sex
Notes:
Parent Information - Father
Name - First/Last *
Street Address *
City, State, Zip *
Religion
Employer *
Occupation
Work Phone Number
Cell Phone Number *
Email address *
Country of Birth
Parent Information - Mother
Name - First/Last *
Street Address *
City, State, Zip *
Religion
Employer *
Occupation
Work Phone Number
Cell Phone Number *
Email address *
Country of Birth
Mother"s Maiden Name
Parent"s Marital Status *
Student resides with *
Custody
If other, explain completely giving names and relationships
Full name of Stepparent
Full name of Guardian (see Addendum #1)
Addendum #1 In an effort to acknowledge the rights of parents regarding access of information, we ask that you submit any court documentation that substantiates your legal status as it relates to the child being enrolled in Sacred Heart School. If this addendum does not apply, choose "not applicable" **Documentation must be submitted to the school as soon as possible, so your application may be processed.** *

SACRAMENTAL INFORMATION
Baptism:
Date

Month Day Year
Date
Church
City/State/Zip
Reconciliation:
Date

Month Day Year
Date
Church
City/State/Zip
First Communion:
Date

Month Day Year
Date
Church
City/State/Zip
Confirmation:
Date

Month Day Year
Date
Church
City/State/Zip
SCHOOL INFORMATION
School Previously Attended:
Address
MEDICAL INFORMATION
Special Medical Information
Family Doctor *
Family Doctor Phone number *
Please list the names, ages, and schools of ALL children in the family
Name - First/Last
Age
School
Name - First/Last
Age
School
Name - First/Last
Age
School
Name - First/Last
Age
School
Name - First/Last
Age
School
If more than 5 children, list here
Is another language spoken at home? *

yes no
If yes, what language

Diocese of Allentown ENGLISH Home Language Survey* The Office of Civil Rights (OCR) requires that the school districts/charter schools/full day AVTS identify limited English proficient (LEP) students in order to provide appropriate language instructional programs for them. Pennsylvania has selected the Home Language Survey as the method of identification.
School District *
Name of child *
Date *

Month Day Year
Date
Address *
Grade
School
Birthplace *
1. What is/was the student"s first language?
2.Does the student speak a language(s) other than English? *

yes no
If yes, specify the language(s)
3. What language(s) is/are spoken in your home?
4. Has the student attended any United States school in any 3 years during his/her lifetime?

yes no
If yes, complete the following:
Name of School
State
Dates Attended start

Month Day Year
Date
Dates Attended end

Month Day Year
Date
Name of School
State
Dates Attended start

Month Day Year
Date
Dates Attended end

Month Day Year
Date
Name of School
State
Dates Attended start

Month Day Year
Date
Dates Attended end

Month Day Year
Date
Person completing this form (if other than parent/guardian)
By checking this box and printing my name below, I am electronically signing this survey *

I have agreed to submit survey electronically
Parent/Guardian signature (print full name) *
*The school district/charter school/full day AVTS has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school/full day AVTS has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school/full day AVTS may conduct screenings or ask for related information about students who are already enrolled in the school as well as from students who enroll in the school district/charter school/full day AVTS in the future.
For Office Use Only Exemption from English Language Proficiency Testing (attach required documentation) (Must meet two out of the three criteria - please indicate with a check the two appropriate criteria met _____ Final grades of B or better in core subject areas (Mathematics, Language Arts, Science, Social Studies) _____ Scores equivalent to Basic performance on district wide assessment (e.g. 4 Sight) _____ Scores of Basic in Reading, Writing and Math on the PSSA

SIGN AND PRINT
By checking this box and printing my name below, I am electronically signing this Admissions Application *

I have agreed to submit application electronically
Signature (print full name) *
Registration fee payment *

I will pay online below I will send a check into the school office I have paid the family fee on a previous application

My Products

Registration 1 Child ($50 + service fee) $ 51.81

Registration Family ($75 + service fee) $ 77.55

Total $ 0.00

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Expiration Date	Postal Code

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