NEW-STUDENT APPLICATION FOR ADMISSION 2016-2017

This on-line application is to be completed in full by the applicant's parent or guardian.

Please fax or mail the following documents to OLMC School: a birth certificate, baptismal, (if applicable), and immunization form

Fax: (203) 238-3629

Mail: Our Lady of Mount Carmel School - 115 Lewis Avenue - Meriden - 06451

Do not select if paying by check. Mail to 115 Lewis Ave. Meriden, CT 06451

$25 - Application Fee

Pre-K 3

Five Full Days (Mon, Tue, Wed, Fri 8:15-2:50, and Thurs. 8:15-2:00)

Five Half Days (Mon-Friday 8:15-11:45)

Three Full Days (Mon, Wed & Fri)

Three Half Days (Mon, Wed & Fri)

Two Full Days (Tues & Thurs)

Two Half Days (Tues & Thurs)

Pre-K 4

Five Full Days (Mon, Tues, Wed, & Fri 8:15-2:50 and Thurs. 8:15-2:00)

Five Half Days (8:15-11:45)

Contact Information

STUDENT NAME

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Home Phone

Gender

Male

Female

Birth Date

Month/Date/Year

Birthplace

Religion

Parish

Location and Date of Baptism

Race/Ethnicity

Federal guidelines require us to record the Race/Ethnicity of every child. You must answer the following question and then indicate your race. Hispanic is considered an ethnicity and not a racial group. If you are of Hispanic ethnicity, you must also select a racial group.

Are you Hispanic/Latino or of Spanish origin?

Yes

Select one or more from the following racial groups:

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White

FAMILY INFORMATION

Student lives with:

Both Parents

Guardian

Father only

Father/Stepmother

Mother deceased

Mother only

Mother/Stepfather

Father deceased

MARITIAL STATUS

Please complete information for:

Father

Stepfather

Guardian

If Guardian (please list relationship)

Full Name

First Name

Last Name

Religion

Organization/Employer

Position

Cell Phone

Work Phone

Work Email

Verify Email

Home Email

Verify Email

Please complete information for:

Mother

Stepmother

Guardian

If Guardian (please list relationship)

Full Name

First Name

Last Name

Maiden Name:

Religion

Organization/Employer

Position

Cell Phone

Work Phone

Work Email

Verify Email

Home Email

Verify Email

Emergency Contact Name and Phone Number

List those who can pick up your child(ren)

List name/address/telephone of previous school

Name

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

Reason for Transfer (if applicable)

For each student application, please provide all applicable documents:

Legal Birth Certificate

Immunization Record

Deposit

Baptismal Certificate

First Communion Certificate

Applicants for Grade 1 (proof of Kindergarten attendance)

Release of records for K-8 students

Language spoken at home:

English

Spanish

Other

Other:

Medical

Doctor:

Phone

Hospital:

Please tell us about your child. Include any information on student learning needs or health related issues.

How/from whom did you hear about Our Lady of Mount Carmel School?

Parents'/Guardian Signature

Appointment with the Principal, Christa Chodkowski

If you have not met with Mrs. Chodkowski, please contact (203) 235-2959 to make an appointment.

Date of Appointment

Time of Appointment