Student Application Form - St. Ann School - Lansing, Illinois

Please complete a separate form for each child you wish to enroll to St. Ann School. If you have any question, please contact Janice Summerrise at 708-895-1661, extension 27.

* Required
*School Year Attending:
*Total number of children in family enrolled in the school:
*Names and Grades of Siblings: (If no other siblings, please enter "None")
*Home Phone:
Mother's Cell Phone:
Father's Cell Phone:
*Student Last Name:
*Student First Name:
Student Middle Name:
*Birth Date: / /
*Oldest/Only Child: Yes   No
Gender: Male   Female
Is this student Hispanic/Latino?: Yes   No
Race:
(check all that apply)
White Asian Black/African American
Native American Alaskan Native Native Hawaiian/Pacific Isl.
Country of Birth:
Year Immigrated (If Applicable):
*Religion: Catholic   Non-Catholic
Identify Religion if Non-Catholic:
Grade level upon entry:
Last school attended name:
Last school attended city:
Student lives with:
Last Name(s):
First Name(s):
Relationship:
Address:
Address Cont:
City:
State:
Zip:
Student lives with other: (If Applicable)
Last Name(s):
First Name(s):
Relationship:
Address:
Address Cont:
City:
State:
Zip:
Publish address in school directory? Yes   No
Baptism Church:
Baptism Date: / /
Reconciliation Church:
Reconciliation Date: / /
First Communion Church:
First Communion Date: / /
Confirmation Church:
Confirmation Date: / /

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