APPLICATION

                                                                                                                                                73 North Hill Avenue
                                                                                                                                                Pasadena, Ca. 91106
                                                                                                                                                (626) 792-7725

      Applying for Grade ___________________________________

     Student's Name _________________________________________________________________________________________
                               Last                                                            First                                                           Middle

     Home Address __________________________________________________________________________________________
                             Street                                                         City                                                                Zip Code

     Home Phone ______________________________________ Date of Birth __________________________________________

     Male ______    Female ______ Child lives with: Both Parents _____ Mother _____ Father ______ Joint _______

     Mother's Name ________________________________________________________________________________________

     Address: (If not same) ___________________________________________________________________________________

     Phone : (If not same) ___________________________

     Work Phone : __________________________________

     Father's Name _______________________________________________________________

     Address ( If not same ) _________________________________________________________

     Phone (if not same) ___________________________________________________________

     Work Phone _________________________________________

     Church Affiliation / Name __________________________________________________________

    Siblings ______________________________                              Grades ____________________

    Name   _______________________________                             Grades ____________________

    Current School ________________________________________ Current Grade _____________

    Need before School Care _________________                           Need after School Care _______

    Parent's Signature _______________________________________ Date ___________________

_______________________________________________________________________________________________________
  OFFICIAL USE ONLY:

  Open House Attended: ___________________________           Transcripts received _____________________

  Open House Attended : __________________________             Recommendation received _______________

  Test Given: _____________                                                          Acceptance letter mailed _________________

  Fee Paid: _______________

APPLICATION

2011-2012