MISSIONDOLORESSCHOOL

3371-16th Street*San Francisco, CA 94114* 415-861-7673

APPLICATION FORM

STUDENT INFORMATION
Please circle grade for which you are applying K 1 2 3 4 5 6 7 8
Student’s Name ______
Last First Middle
Home Address ______
Number and Street City State Zip Code
______
Area code and phone number Social Security number
______
Date of Birth Birthplace (City/State/Country)
______
Country of citizenship Religion
Sacraments received: check where applicable
Baptism _____ Holy Communion ______Confirmation ______
Child’s Ethnic Background (check appropriate spaces)
Native American ____ Chinese ___ Latino___ Pacific Islander ___ Filipino ___ White _____
African American ____ Japanese ___Multi-racial ___Other Asian ___
Primary language spoken at home ______
Applicant lives with (check appropriate spaces)
Both parents ____ Mother only ____ Father only ____ Mother /father joint custody ____
Stepfather (mother remarried) ____ Stepmother (father remarried) ____
Grandparent _____ Guardian ______
Full legal and financial responsibility for this applicant is with (check appropriate spaces)
Both parents ____ Father only ___ Mother only ____ Mother/Father shared responsibility ____ Grandparent ___ Guardian ____ Stepmother ____ Stepfather ____

PARENT/GUARDIAN INFORMATION

Mother’s Name ______
Maiden First Middle
Home Address ______
Number and Street City State Zip Code
______
Home Phone number Mobile phone Email
Religion______Occupation______Work Phone______
Employer ______
Employer’s Address ______
Number and Street City State Zip Code
Father’s Name ______
Last First Middle
Home Address ______
Number and Street City State Zip Code
______
Home Phone number Mobile phone Email
Religion ______Occupation ______Work Phone ______
Employer______
Employer’s Address ______
Number and Street City State Zip Code

Catholic Families:

Name of Parish in which you are registered ______

Are you active in this parish? ___ Yes ___ No

List schools your child has attended or is currently attending::

SCHOOL / ADDRESS / GRADE

Why have you chosen to apply to Mission Dolores, a Catholic school?

______

______

______

Do you feel you have a commitment to the religious instruction and up-bringing of your child?

Please explain.

______

______

______

Please submit the following items with your application form:

1)A non-refundableApplication Fee of $30.00 (checks payable to: MissionDoloresSchool)

2)A copy of Baptismal Certificate for Catholic children

3)A copy of Birth Certificate

4)A copy of child’s Most Recent Report Card for students applying to Grades 1-8

5)A copy of a Progress Reportfrom their pre-school for children applying for Kindergarten

CHARGES AT OTHER PRIVATE/PAROCHIAL SCHOOLS MUST BE PAID BEFORE STUDENTS WILL BE GIVEN ANY NOTICE OF ACCEPTANCE. WE RESERVE THE RIGHT TO CONTACT FORMER SCHOOLS RE: ACCOUNTS AND ACADEMIC OR BEHAVIORAL PROGRESS.

Parent signature ______Date______

Print Name ______

MissionDoloresSchool admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color or ethnic origin in administration of its educational policies, scholarships and athletic and other school administered programs.

OFFICE USE ONLY
Date
Fee Check Cash
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