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St. Bernard's High School Application
Please fill out the following form to submit your application to St. Bernard's High School.
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* Indicates required question
Email
*
Your email
First Name (Student)
*
Your answer
Middle Name (Student)
Your answer
Last Name (Student)
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zipcode
*
Your answer
Gender
*
Female
Male
Date of Birth (Student)
*
MM
/
DD
/
YYYY
Applying for grade:
*
9th grade
10th grade
11th grade
12 grade
For the academic year:
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2019 - 2020
2020 - 2021
Present School
*
Your answer
Number of Years Attended
*
Your answer
Name of Parent/Guardian #1
*
Your answer
Phone Number of Parent/Guardian #1
*
Your answer
Address of Parent/Guardian #1 (if different from student)
Your answer
E-mail of Parent/Guardian #1
*
Your answer
Occupation of Parent/Guardian #1
*
Your answer
Place of Employment of Parent/Guardian #1
Your answer
Name of Parent/Guardian #2
Your answer
Phone Number of Parent/Guardian #2
Your answer
Address of Parent/Guardian #2 (if different from student)
Your answer
E-mail of Parent/Guardian #2
Your answer
Occupation of Parent/Guardian #2
Your answer
Place of Employment of Parent/Guardian #2
Your answer
Names of Siblings Currently Enrolled at St. Bernard's High School (if applicable):
Your answer
Names and Graduation Years of St. Bernard's High School Alumni in Family (if applicable):
Your answer
Student's Top Choices for High School (please include three):
*
Your answer
Student's Current Average in Mathematics:
*
A
B
C
D
Currently failing Math
Student's Current Average in English Language Arts (ELA):
*
A
B
C
D
Currently failing ELA
Does the student have a current IEP or 504 plan?
*
Yes
No
If yes, please briefly explain the student's IEP/504 plan and current accommodations:
Your answer
Student's Academic Interests (include all applicable):
*
Mathematics
Science
Technology
English Language Arts
Writing
History / Social Studies
Art
Foreign Language
Gym / Health
Religion
Other:
Required
Student's Extra-Curricular Interests (include all applicable):
*
Community Serivce
Athletics
Art
Theater
Dance
Music
Journalism and Writing
Graphic Design and Publication
Science and Technology
Student Government
Other:
Required
Please describe student's college and/or career goals, if known:
Your answer
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