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Saint Augustine Academy

FAMILY ADMISSION QUESTIONNAIRE
(Please use Sibling Questionnaire for additional applicants)
Application Fee of $50.00 per child

Date:___________________________________
School
Applying for Grade _____ Year _____________

Applicant's Name____________________________________________________________________________
Last
First
Middle
Preferred Name__________________________

Phone No. (___)_________________________________

Home Address______________________________________________________________________________
Street
City
State
Zip
__________________________________________________________________________________________
Date of Birth
Age
Place of Birth
Country of Citizenship
__________________________________________________________________________________________
Native Language
Religious Preference
Parish or Church
__________________________________________________________________________________________
Date of Baptism
Date of First Communion
Date of Confirmation
How did you learn about St. Augustine Academy?_________________________________________________
__________________________________________________________________________________________
FAMILY INFORMATION

Father’s E-MAIL:_______________________________________
Mother’s E-MAIL:______________________________________

Are both parents living?_______ Are parents divorced?_______ Separated?_______ Remarried?_______
Does applicant live with both parents?_______ Mother_______ Father_______ Guardian_______
Is he/she adopted?___ Do other adults live at home?___ Names and Role_______________________________
Father's Name

Work or Cell Phone (___) __________

Home Address (if diff. from above)_________________________________Religious Preference_____________
Place of work_______________________________________________ Work Phone (___)_________________
Work address______________________________________________ Position or Title___________________
College(s) attended_________________________________________

Degree(s)________________________

__________________________________________________________________________________________

Mailing Address: P.O. Box 4506, Ventura, CA 93007
130 South Wells Road, Ventura CA 93004  (805)672-0411  Fax (805)672-2365
www.SaintAugustineAcademy.com  e-mail StAugAcad@juno.com
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CA 93007 130 South Wells Road. athletic. from above)_________________________________Religious Preference Place of work__________________________________________________ Work Phone (___) Work address___________________________________________________Position or Title College(s) attended______________________________________________Degree(s) Mother’s hobbies or special interests: (Including musical.O. grade levels and curricula used. Ventura CA 93004  (805)672-0411  Fax (805)672-2365 www. computer.) If applicant has been home-schooled. crafts.Saint Augustine Academy Father’s hobbies or special interests: (Including musical.) Names and Ages of Siblings School Currently Attending VOLUNTEER WORK: Please list present and past involvement in diocesan. Ventura.) Mother’s Name____________________Maiden Name____________Work or Cell Phone(_____) Home Address (if diff. School Location Attendance Dates Mailing Address: P.com  e-mail StAugAcad@juno. computer. Box 4506. dramatic.SaintAugustineAcademy. etc. parish. dramatic. please list length of time. crafts. (An official transcript will be necessary before high school admission. athletic. apostolic or civic groups with which you have donated your time.com 2 . etc. SCHOOL HISTORY List names of schools applicant has attended.

socially. please list date. Box 4506. name and address of consultants and describe situation briefly. Augustine? Mailing Address: P.SaintAugustineAcademy. PARENT QUESTIONNAIRE In order for us to get to know you and your child better.) Does applicant suffer from any specific health conditions that we should be aware of? Please explain: Does he/she require any special attention? Is he/she currently taking any medication?____If so.Saint Augustine Academy Has applicant ever skipped a grade?_____ If so. and/or morally)? What do you expect from us and from your child(ren) at St. please answer the following questions: What would you say are your child's main assets. Ventura CA 93004  (805)672-0411  Fax (805)672-2365 www. CA 93007 130 South Wells Road. what grade? Does the applicant have any diagnosed physical or learning disabilities?_____ If yes.O. what and at what age? Has he/she ever had a serious injury?____If so. in what areas? If you are transferring. qualities. what kind? Has applicant ever had an operation?___ If so. strengths and talents (academically.com  e-mail StAugAcad@juno. physically. Ventura. what grade?_____ Repeated a grade?_____ If so. therapist or counselor? If so.com 3 . please describe: Has he/she had academic problems?___ If so. why do you wish to transfer? MEDICAL INFORMATION (A medical examination and certificate signed by the doctor are required before enrollment. what and at what age? Has applicant stayed home from school repeatedly or for long periods due to illness? Please explain: Has applicant ever received special attention or evaluation from a psychologist.

O.Saint Augustine Academy What kinds of activities do you enjoy doing together as a family? What kind of discipline/reward system do you practice at home? ******************************************************************************************** I hereby certify that all information provided on this application and all information given to St. CA 93007 130 South Wells Road.# ___ Copies of any report cards or Standard Tests ___ Letter of recommendation for children entering Comments: grade 7 or above. I understand that all information submitted to St. is complete and accurate. Parents' or guardians' signatures: Date: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Checklist: Requirements for Admission We must receive the following items WITH this form in order to consider your application. Augustine Academy. Ventura. and I understand that falsification or omission of information may result in disqualification or dismissal. ___ Copy of Baptismal Certificate Date Ck.00 ___Immunization Records Checklist: Additional Documents Needed OFFICE USE ONLY: These items can be submitted following submission ofAccepted: initial application forms: Not Accepted: ___ Medical examination statement from doctor App.SaintAugustineAcademy. any information received from the applicant according to his discretion. Box 4506. for official purposes. entering 7th.com 4 . Fee Pd. 8th and 9th grades Comments: Mailing Address: P. Furthermore. Augustine Academy is confidential and that the Director of Admissions may disclose. Ventura CA 93004  (805)672-0411  Fax (805)672-2365 www. ___Completed Application Form ___Copy of Birth Certificate ___ Application and Testing fee of $50.com  e-mail StAugAcad@juno.

doc Mailing Address: P.) Why do you want to come to St. and activities do you most enjoy outside of school? ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ What is your favorite academic subject and why? ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Please describe an event that has had a special impact or significance in your life? ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ SUDENT ESSAY: Grades 4-12 Applicants . CA 93007 130 South Wells Road. sports.com 5 .SaintAugustineAcademy. Ventura CA 93004  (805)672-0411  Fax (805)672-2365 www. Augustine Academy? C:\Documents and Settings\User\My Documents\Admissions\Application for Admission. Ventura.com  e-mail StAugAcad@juno.Saint Augustine Academy STUDENT QUESTIONNAIRE – (Optional for Lower School Students.O.(Please neatly handwrite on a separate sheet of lined paper. Box 4506. K-3) What hobbies.