Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Application/Testing Form
2016-2017
Return this form (one per new student) to Mary Immaculate School with a money order or cash in the amount of $50.00, when applying for Pre-Kindergarten – Eighth Grade. This application/testing/assessment fee is non-refundable. Incomplete applications will be returned.
Please print or type all information in black ink.
Student Information:
Grade Entering in September 2016:
Complete Legal Name:
First Middle Last
Birthplace (City and State and/or Country):
Date of Birth: month: day: year:
Social Security #:
Home Address:
City: Zip:
Religion:
If Catholic, please complete the following:
Baptismal Information:
Parish:
City and State:
Date of Baptism:
Has the child received First Reconciliationyesno
If yes, please complete the following:
First Reconciliation Information:
Parish:
City and State:
Date of First Reconciliation:
Has the child received First Communionyesno
If yes, please complete the following:
First Communion Information
Parish:
City and State:
Date of First Communion:
Name of school in which child is currently enrolled in the 2015-2016 school year:
Address:
City: Zip: Phone No.:
Parent Information (Father)
Complete Legal Name
First: Middle: Last:
Home Address:
City: Zip:
Home No.: Work No.: Cell No.:
Birthplace (City and State and/or Country):
Social Security #:
Occupation: Place of Employment:
Religion:
If Catholic, please complete the following:
Are you registered in Mary Immaculate Parish?Yes____no
If yes, please provide your envelope number:
If no, in which Parish are you registered?
Parish: City and State:
Parent Information (Mother)
Complete Legal Name
First: Middle: Last:
Home Address:
City: Zip:
Home No.: Work No.: Cell No.:
Birthplace (City and State and/or Country):
Social Security #:
Occupation: Place of Employment:
Religion:
If Catholic, please complete the following:
Are you registered in Mary Immaculate Parish?Yes____no
If yes, please provide your envelope number:
If no, in which Parish are you registered?
Parish: City and State:
Marital Status of Child’s Parents
Please check one
MarriedDivorced_Separated__Not Married___
Indicate name of child’s legal guardian:
For Office Use Only:
Date received:Form of Payment: cash/check/money order
Amount received: $Check or M.O. # (if applicable):
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
New Student Tuition and Fees Policy
2016-2017
The following fee is due at the time of application to the school office:
$50.00 (cash or money order) application/testing/assessment fee per child (non-refundable):
# of children x $50.00 = $
Registration may be only completed after the child passes the placement test/assessment. Children who score one or more years below grade level may be required to enter Mary Immaculate School repeating their current grade.
The following fees are due at the time of registrationto the school office along with the SMART application:
- Registration Fee (non-refundable) – February 19, 2016
$60.00 all children in Pre-Kindergarten
$60.00 first child in family grades K – 8 only
$40.00 each additional child in family grades K – 8 only$ ______
The registration fee is due as well as the special fees listed below and are payable upon acceptance into the school. Without this payment and contracts, registration for the 2016 - 2017 school year is not complete, and the student will not be permitted to attend Mary Immaculate School.
Special Fees – (All fees below are non-refundable) – February 19, 2016
- All grades: $75.00 per child (Technology/Computer Lab Fees) (2 1/2 year olds do not pay this fee)
$35.00 per family (Smart Tuition Systems)
Grades K-8:
Kindergarten:$50.00 per child (Special Celebration and Certificate)
Grade 2: $50.00 per child (First Eucharist Celebration)
*Please note: The school and parish First Reconciliation and Communion Programs will
be combined together, following the Archdiocese Program Guidelines.
Grade 7:$75.00 per child (Retreat)
Grade 8:$125.00 per child (Retreat and Graduation)
Sports/Teams’ Fee:$75.00 per participating child, per sport (to be collected during the
sport season)
The following NON-REFUNDABLE fees apply and are due no later than date specified:
Fundraising Fee – March 17, 2016. Please Note – Fundraising Fee is submitted to the SMART Tuition Company where the $325.00 fee will automatically be deducted from your saving/checking account.
$325.00 per family (which includes)(325) Three Hundred Raffle Tickets (September Back-to-School Night)
Other fundraisers throughout the school year will be optional.
B. Books/Classroom Materials – April 15, 2016. Please Note – Book Fee/sis/are submitted to the SMART Tuition Company where the calculated fee will automatically be deducted from your saving/checking account.
- Pre-Kindergarten - $100.00
- K - Kindergarten - $150.00
- Grade One - Grade Eight - $200.00
C.Non-participation in Service Hours (40 hours):
- $400.00 per family; $200 (per semester) will be submitted to the SMART Tuition Co.in the month of January and May 2017 where the calculated fee will automatically be deducted from your saving/checking account. Please note – Extra service hours are not transferable between semesters or between school parents. PLEASE NOTE – Charity donations are for your own tax deductions and will not count towards school volunteer service hours.
Please note this fee is optional and payable only after deciding not to participate. Mary Immaculate School highly encourages parental participation.
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Tuition for PK Students Only
2016-2017
(Please Note – Tuition and registration for PK students are separate from tuition and registration for K-8th grade students. Additionally, the below noted rates of tuition include a beverage and a snack for PK students plus the tuition and registration paid for PK students are tax deductible. Please keep in mind that the PK tax deductible tuition and registration are for those parents who have children in PK only.)
There are (2) two levels of tuition for 2016 – 2017:
C) Contributing to Mary Immaculate Parish
D) Non-contributing to Mary Immaculate Parish
Contributing:
This level requires that the family:
c)register at Mary Immaculate Church
d)use Parish envelopes and contribute weekly to the Sunday Collection using these envelopes
Families who sign up for this level of tuition will be monitored monthly. Failure to meet the above requirements will result in a“non-contributing” status. Families who are returning will be assessed of their status and will be notified prior to acceptance.
The rates for contributing members are as follows:
NUMBER OF CHILDRENAMOUNT
(1)One (2 ½ -year old 7:30-11:30 am)$3,600 ($360 per month for 10 months)
(2)One (2 ½ -year old 7:30am-2:45pm)$4,600 ($460 per month for 10 months)
Please Note – Potty trained preferred. CCRC accepted. Daycare available up to 5PM at the rate of $30 per week.
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(3)One (3 year old 7:30-2:45 pm)$4,100 ($410 per month for 10 months)
(4)Two (3 year old 7:30-2:45 pm$6,800 ($680 per month for 10 months)
Please Note – CCRC accepted. Daycare available up to 5PM at the rate of $30 per week.
Non-Contributing:
This level implies that the family has not chosen to:
b) register at Mary Immaculate Church
The rates for non-contributing members are as follows:
Number of childrenAMOUNT
(1)One (2 ½ year old 7:30-11:30 am)$4,400 ($440 per month for 10 months)
(2)One (2 ½ year old 7:30am-2:45pm)$5,400 ($540 per month for 10 months)
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(3)One (3-year old 7:30am-2:45 pm)$4,900 ($490 per month for 10 months)
(4)Two (Twin Sibling) (3-year old$7,700 ($770 per month for 10 months)
7:30am-2:45pm)
It should be noted that priority for admission to school is given to active members of Mary Immaculate Parish. Space is provided to non-parishioners after all applications from parishioner families are filled.
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Tuition for K- 8th Grades Only
2016-2017
(Please Note- Tuition for K- 8th grade students
is separate from tuition for PK students)
There are (2) two levels of tuition for 2016 – 2017:
A)Contributing to Mary Immaculate Parish
B)Non-contributing to Mary Immaculate Parish
Contributing:
This level requires that the family:
a)register at Mary Immaculate Church
b)use Parish envelopes and contribute weekly to Sunday collections using these envelopes.
Families who sign up for this level of tuition will be monitored monthly. Failure to meet the above requirements will result in a “non-contributing” status. Families who are returning will be assessed of their status and will be notified prior to acceptance.
The rates for contributing members are as follows:
NUMBER OF CHILDRENAMOUNT
(1) One$3,800 ($380 per month for 10 months)
(2) Two$5,200 ($520 per month for 10 months)
(3) Three$6,400 ($640 per month for 10 months)
(4) Four$7,200 ($720 per month for 10 months)
(5) Five$8,100 ($810 per month for 10 months)
Non-Contributing
This level implies that the family has chosen not to:
a)register at Mary Immaculate Church
The rates for non-contributing members are as follows:
NUMBER OF CHILDRENAMOUNT
(1) One$4,600 ($460 per month for 10 months)
(2) Two$6,000 ($600 per month for 10 months)
(3) Three$7,500 ($750 per month for 10 months)
(4) Four$8,400 ($840 per month for 10 months)
It should be noted that priority for admission to school is given to active members of Mary Immaculate Parish. Space is provided to non-parishioners after all applications from parishioners are filled.
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Mission Statement
The Mission of Mary Immaculate School,
in partnership with families,
is to serve God throughfaith, love, and respect
while inspiringlearning, leadership, and service.
Our school promotes a safe and supportive learning environment
that helps foster each student’s academic and social success.
As Catholic Christian educators,
we strive to empower each child to become a
life-long learner,contributing member of the community, and
tomorrow’s Christian leader.
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Re-Registration Form
2016-2017
To re-register, all outstanding 2015-2016 balances that are currently due must be paid. Additionally, this form, the re-registration fee, special fees and the contract must be returned to Mary Immaculate School by February 19, 2016. After February 19th, all applicants (including returning students) will have to re-apply for admission to Mary Immaculate School, which will require re-testing for admission.
(Please fill in completely with type or print)
Family Name: In-Parish Envelope #
Address: Telephone:
City: Zip Code:
Father’s Name:
Mother’s Name:
Name(s) of Child(ren):Please Circle OneGrade in Sept. 2016
will/will not return
will/will not return
will/will not return
will/will not return
Name of Child
I/We have a new incoming child of PK age (2 ½ -4)bySept. 1 2016.yes/no
I/We have a new incoming child of Kindergarten age (5)bySept. 1 2016.yes/no
I/We have a new incoming child in Grade in Aug. 2016.yes/no
If yes, please contact the office for an application form. Please note: you must submit Application Form and Testing/Assessment Fee for all incoming siblings by February 19, 2016.
PLEASE NOTE AGE REQUIREMENTS FOR 2016-2017
PK:Age (2 ½ -4) bySeptember 1, 2016
Kindergarten:Age (5) five by September 1, 2016
Grade One: Age(6) six by September 1, 2016(for any new students entering Grade One in 2016-2017).
Signature (responsible party)Date
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551Fax (818) 896-7996
Registration Fees
2016-2017
Family Name:
Name(s) of Child(ren):
The following fees are due at the time of registrationto the school office:
- Registration Fee (non-refundable):
$60.00 all children in PK
$60.00 first child in family grades K – 8 only
$40.00 each additional child in family grades K – 8 only$ ______
The registration fee is due as well as the special feeslisted belowto the school office and are payable no later than February 19, 2016. Without this payment andschool and SMART contracts, registration for the 2016 - 2017 school year is not complete, and the student will not be permitted to attend Mary Immaculate School.
Special Fees – (All fees below are non-refundable) – February 19, 2016
- All grades: $75.00 per child (Technology/Computer Lab Fees)(2 ½ year olds do not pay this fee)
$35.00 per family (Smart Tuition Systems)
Grades K-8:
Kindergarten:$50.00 per child (Special Celebration and Certificate)
Grade 2: $50.00 per child (First Eucharist Celebration)
*Please note: The school and parish First Reconciliation and Communion Programs will be combined together, following the Archdiocese Program Guidelines.
Grade 7:$75.00 per child (Retreat)
Grade 8:$125.00 per child (Retreat and Graduation)
Sports/Teams’ Fee:$75.00 per participating child, per sport (to be collected during the
sport season)
The following NON-REFUNDABLE fees apply and are due no later than date specified. Please Note – The feesnoted below will be submitted to the SMART Tuition Company where the fees will automatically be deducted from your saving/checking account on the dates noted below.
Fundraising Fee – March 17, 2016:
$325.00 per family (which includes)(325) Three Hundred Raffle Tickets (September Back-to-School Night)
Other fundraisers throughout the school year will be optional.
Books/Classroom Materials – April 15, 2016:
- Pre-Kindergarten - $100.00
- Kindergarten - $150.00
- Grade One - Grade Eight - $200.00
Please Note: The SMART Tuition Co. will apply a$35 per month late fee to all payments not made in full (each month following) until full payment is received.
I have been informed about the above-mentioned fees for the 2016-2017 school year and agree to have the SMART Tuition Company withdraw payments from my checking/savings account on the dates noted above (3/17 & 4/15).
_____
Signature (responsible party) Date
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Service Hours
2016-2017
Family Name:
Name(s) of Child(ren):
Service hours for this school year are as follows: 20 hours($200.00) per two trimesters, 40 hours per school year ($400.00).
Service hours must be complete by:
- First Trimester – January 8, 2017
- Third Trimester – May 20, 2017
Please Note – All service hours that are not complete by the above date will be billed at $10.00 per uncompleted service hour.One office bill will be sent in January at the time of Re-Registration with a due date and Second office bill will be sent in May with a due date. If payment not received in the office by the due date, the fee will be submitted to the SMART Tuition Co.where the fee will automatically be deducted from your saving/checking account.
Service Hours in the 2016-2017 school year can only be completed in the following (4) four ways:
- Planning and working fundraisers
- Yard Supervision
- Transport of Students to Sport Activities
- Donations (All items purchased for Bake Sales and Fundraisers require a receipt in order to receive credit.) PLEASE NOTE – Charity donations are for your own tax deductions and will not count towards school volunteer service hours.
- 20 hours for school events and 20 hours for parish ministry and fiesta.
There is an option to pay for your service hours instead of participating. If this is your preference then following fee then applies:
- Non-participation in Service Hours (40 hours):
- $400.00 per family; $200.00 (per two trimesters [by Jan & by May]) will besubmitted to the SMART Tuition Co. Please Note – Extra service hours are not transferable between trimesters or between school parents.
Please note: This fee is optional and payable only after deciding not to participate. Mary Immaculate highly encourages parental participation.
I have been informed about the Service Hours requirements for the 2016-2017 school year and agree to – (please check one of the options below) –
____ participate in Service Hours Activities ____ pay the Service Hour Fees
for the 2016-2017school year according to the above noted
Signature (responsible party)Date
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Tuition Contract and Payment Preference
2016-2017
This contract is due no later than February 19, 2016. Without theappropriate payment (including any outstanding balances), school andSMART contracts, registration for the 2016-2017 school year is not complete, and the student will not be enrolled at Mary Immaculate School. Also, the signature of the responsible party of this contract noted below has the financial responsibilityfor all outstanding balances. Parent/guardian signature is also required as consent to having your child/ren attend Mary Immaculate School.
Family Name:
Name(s) of Child(ren):
Tuition for the 2016 – 2017 school year will be paid by one of (2) two options:
(Please check the appropriate box)
Option 1Single payment due June 24, 2016, to the school office. A 4% discount on theannual tuition rate isgiven to the parents who choose “Option 1” and who pay in full by June 24, 2016. The $35 SMART Tuition System registration fee will also be waived.
Option 2Monthly Payment Plan will be collected by the SMART Tuition Co according to the option selected. Payments arebudgetedover 10 months beginning August 2016.Payments must
be made by the firstof each month, (delinquent on the 11th), otherwise they will be considered late.
Note: The school has the right to withdraw your child(ren) in failure to comply with the
school fees, policies or procedures should occur at any time throughout the school year. Likewise, your child(ren) will not be allowed to begin the new school year if you have an outstanding balance. All balances must be paid before the 1st day of the school year
2016 – 2017.
A $35.00 per month late fee charged by SMART Tuition Co. applies to all payments/fees
not made IN FULL on date due EACH MONTH UNTIL FULL PAYMENT IS RECEIVED.
I agree to pay tuition for the 2016 – 2017 school year according to Option #, noted above.
Signature (responsible party)Date
______
Signature (Parent/Legal Guardian)Date
Mary Immaculate School
10390 Remick Avenue Pacoima, California 91331
Phone (818) 834-8551 Fax (818) 896-7996
Tuition for PK Students Only
2016-2017