St. Michael Catholic School
704 St. Michael Lane
Gastonia, NC 28052
704-865-4382
www.SMSGASTONIA.com
Sschool792@aol.com
New Student Admission Application
Grades Kindergarten through 8th Grade
Please complete this application and return it to St. Michael’s School with the following:
* $25 non-refundable application and testing fee (for new families) to initiate the
admissions process. (Make checks payable to St. Michael School)
* Copy of the birth certificate
* Copy of the student’s baptismal certificate if student is Catholic
* Proof of Physical Exam and Immunization (Health form enclosed)
* Parish Participation Voucher if applicable (enclosed)
* Copy of the student’s current year report card & previous year final report card.
* Copy of the student’s current & previous year standardized test scores.
FAMILY INFORMATION
Father’s Name (or Legal Guardian)_____________________________________
Address ________________________________________________________
City_________________________ State ____________Zip Code __________
Home Telephone_______________Cell Phone Number ___________________
Work Telephone_______________Other Phone Number__________________
Email Address______________________________________
Occupation ________________________Employer _______________________
Religion __________________________Name of Church __________________
City_____________________________ State ________ Zip Code __________
Mother’s Name (or Legal Guardian)____________________________________
Address _________________________________________________________
City____________________________State __________ Zip Code __________
Home Telephone___________________Cell Phone Number ________________
Work Telephone___________________Other Phone Number_______________
Email Address________________________________________
Occupation _______________________Employer ___________________________
Religion _________________________Name of Church ______________________
City____________________________State ____________Zip Code__________
Student Information
Full Name_________________________Preferred Name_____________Grade ______
Male______Female_______ Date of Birth______________________________
Social Security Number______-_____-______
Religion _______________________ Has student been baptized? Yes _____ No _____
Has student received First Eucharist? Yes____No____If yes, date received____________
Last School Attended__________________________ Last Grade Completed ________
City, _____________________________ State________ Zipcode_________________
Telephone Number _________________________
Full Name_________________________ Preferred Name____________Grade ______
Male______Female_______ Date of Birth___________________________________
Social Security Number______-_____-______
Religion ______________________Has student been baptized? Yes _____ No _____
Has student received First Eucharist? Yes___ No____If yes, date received____________
Last School Attended______________________Last Grade Completed ____________
City, __________________________ State_________Zipcode_________________
Telephone Number _________________________
Full Name________________________Preferred Name____________Grade ______
Male______Female_______ Date of Birth_________________________
Social Security Number______-_____-______
Religion ________________________ Has student been baptized? Yes _____ No _____
Has student received First Eucharist? Yes__No___If yes, date received_____________
Last School Attended______________________ Last Grade Completed __________
City, ________________________, State_________Zipcode____________
Telephone Number _________________________
Please state the reasons for wishing to enroll your child(ren) in St. Michael Catholic School
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Signature of Parent or Legal Guardian Printed Name of Parent or Legal Guardian
Date: ___________________________
How were you refereed to Saint Michael School: (Please circle one)
Advertisement Church SMS Family Other _______________
If referred by a Saint Michael School Family, please list family primarily responsible for
referring you: