Admissions Application

APPLICATION FOR ENROLLMENT

To avoid a delay in processing your application, ALL sections of the application must be completed by the parent or legal guardian.

STUDENT INFORMATION:

Name of Student Applicant:

Student Address:

City:

County:

Zip:

Phone Number:

Student Date of birth:

Age:

Sex:

Student SSN:

School Last Attended:

FAMILY INFORMATION:

Father’s Name:

Employment:

Position:

Business Phone:

Mother’s Name

Employment:

Position:

Business Phone:

Parent/Guardian Work Phone:

Emergency Contact Person:

Emergency Contact Telephone Number:

MEDICAL INFORMATION:

Name of Family Physician:

Family Physician Telephone:

Does student have any physical challenges or allergies

If yes, explain:

SCHOLASTIC INFORMATION:

Has student ever had disciplinary difficulty at school?

If yes, explain:

Has student ever failed an academic subject at school?

If yes, explain:

Please indicate academic level of student’s previous work:

DISTRICT OF RESIDENCE:

Name of School the student is currently enrolled in:

Student's grade level for the current school year:

Student's grade level for the upcoming school year:

Does the student have a current IEP (Individual Evaluation Plan)?

If yes, attach a copy

Does the student have a 504 Plan (Accommodation Plan)?

If yes, attach a copy

Grade level in which the student is applying for this current school year:

If the student has a sibling already enrolled at St. Anthony's, please enter their sibling's name(s) and grade level(s).

Have you received a Confirmation or Award Letter of Student Enrollment/Eligibility from AAA or Step Up for Students for your child? If yes, attach a copy.

Attach a copy.

I received the Confirmation of Student Enrollment/Eligibility from my Resident district.

I confirm that my student will be enrolled in a FL public school for the entirety of the school year.

My student is applying to Step Up for Students because he/she is a FL resident who attended a public school in his/her resident district for the entire year immediately prior to enrollment.

Falsifying any information on this application will result in the denial of the student's participation in the School Program.

** Withdrawal of your child, prior to the end of the school year, will require a $500.00 administrative fee before any transcript or any release of the scholarship, to any other institution will be complete.

By my signature, I certify that I have satisfied the requirement that a Notice of Intent to Participate in the School Scholarship Program was provided to the School by me and that I am applying for my student's admission.

SIGN:

PRINT:

DATE:

(Signature of Person Responsible for Student’s Account)

DATE:

Address

Social Security Number

Relationship to Student

Home#

Work#

Cellular#

Contact

Address

18441 NW2nd Ave,
4th Floor Miami, FL 33169

Mailing Address

7972 Pines Blvd., #245723, Pembroke Pines, FL 33024

Phone

(786) 320-6289

stanthonyssohe@gmail.com