Online Application

Student Name*
First Middle Last
- Male
- Female
Date of Birth (MM/DD/YYYY)*
Date Format: MM slash DD slash YYYY
Student's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Is your student Catholic?*
- Yes
- No
*Religion has NO effect on acceptance. For internal use only.
If yes, with what Syracuse Diocesan parish is your family registered?
Ethnic Background of Student (optional)
*This information is used to complete the New York State Basic Educational Data Systems Report that all public and non-public schools are required to submit
School Currently Attending*
School District of Residence
Current Grade Level*
Grade Applying For*
School Year Applying For*
Brief Reason For Leaving*
Applicant Has:*
- 504 Plan
- IEP Plan
- N/A
Parent/Guardian #1*
First Last
*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Relationship to Student
Email
Phone
Parent/Guardian #2
First Last
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Relationship to Student
Email
Phone
Application Fee*
Price: $30.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name