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NCCHS Registration Application 2023-24
Welcome to Newport Central Catholic High School.
Newport Central Catholic High School
13 Carothers RD
Newport, KY 41071
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Email
*
Your email
Grade level for 2023-24
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Freshman
Sophomore
Junior
Senior
Student's Last Name
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Your answer
Student's First Name
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Your answer
Student's Middle Name
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Your answer
Student's Date of Birth
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MM
/
DD
/
YYYY
Student's Address
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Your answer
Student's City
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Your answer
Student's State
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Your answer
Student's Zip code
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Your answer
Students' Ethnicity/Race
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American Indian/Native American
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/Pacific Islander
White
2 or more races
Student's Gender
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Male
Female
Home Phone Number
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Your answer
Grade School Attended
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Your answer
Religion
Catholic
Christian, Non-Catholic
Non-Christian
Clear selection
Parish, if applicable. Otherwise list "n/a"
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Your answer
Student lives with-
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Both parents
Mom
Dad
Other
If student lives with "Other," please indicate relationship
Your answer
If there is a guardianship decree preventing someone from picking up, please indicate the name and relationship here. **Legal documents will be required.
Your answer
Father's Name
Your answer
Father's address *if different from the student's
Your answer
Father's email address
**Must be provided for gradebook access invitation
**Gradebook access must be created to receive school communications, newsletters, etc
Your answer
Father's home phone
Your answer
Father's call phone
Your answer
Father's work phone
Your answer
Mother's Name
Your answer
Mother's address *if different from the student's
Your answer
Mother's email address
**Must be provided for gradebook access invitation
**Gradebook access must be created to receive school communications, newsletters, etc
Your answer
Mother's home phone
Your answer
Mother's cell phone
Your answer
Mother's work phone
Your answer
If applicable- List and additional parent or guardian's name(s), relationship(s), address(s), email(s), and phone number(s)
Your answer
List any significant health problems or handicaps of which the school should be aware
Your answer
Other concerns (Learning Disability, Special Education Programs, previous IEP or IAP on file)
Your answer
In the event of an emergency, if parents can't be reached, please contact the following. (Include name, number, and relationship). At least one emergency contact is required.
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Your answer
Each potential Newport Central Catholic student must provide the name and email address for (2) teachers and/or staff members of his/her current school as references.
Name and email address for reference 1
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Your answer
Each potential Newport Central Catholic student must provide the name and email address for (2) teachers and/or staff members of his/her current school as references.
Name and email address for reference 2
*
Your answer
Digital signature required
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Your answer
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