St Theresa School

St. Theresa School does not discriminate on the basis of sex, race, color, religion, or national origin in the administration of adminssions and educational policies, financial assitance or other school related activities.

Please complete one form for each child applying. Thank you.

Applicant Information

Academic Year

2019-20 OR Current year 2018-19

Kindergarten

Morning (7:40 - 12:00)

All Day

Before or After School Care

Morning

Afternoon

Both

Unsure

Student name *

LAST, FIRST, MIDDLE

Nickname

Date of Birth *

MM/DD/YYYY

Place of birth*

(city, state or country) Please scan birth certificate

Is the student Hispanic or Latino?*

Yes

What is the student's race?

check all that apply

American Indian or Alaska Native

Asian

Black or African American

Multi-racial

Native Hawaiian/Pacific Islander

White

Country of Birth (if not from the US)

Primary Address

Street Address*

City*

State*

Zip/Postal*

If "Other"

Religion

If Catholic, was your child Baptized?

Yes

Name of Church where your child was Baptized (if Catholic)

Communion

Yes

Languages spoken at home*

Medical Conditions or Allergies we should be aware of?*

Yes

Please list Allergies or Medical conditions (if applicable)

Family Information

Home Phone

Area Code and Phone Number

Mother's Name / Guardian *

LAST, FIRST

Email*

Cell Phone*

Employer

Work Phone

Occupation

Marital Status*

married, separated, divorced, single

Father's Name / Guardian *

LAST, FIRST

Email*

Cell Phone*

Employer

Work Phone

Occupation

Marital Status*

married, separated, divorced, single

Student Lives with:*

Both

Mother

Father

Other:

If applicant does not live with both parents in one household, please describe living arrangements:

Please indicate to whom all school's communication should be directed:*

Who will be financially responsible for the education of this child?*

Would you like us to send you information about financial assistance?*

Yes

Sibling Information

Is Applicant oldest or only child?*

Yes

1. Sibling's Full Name (if applicable)

Gender

Male

Female

Sibling's Birth Date

Siblings Current School and Grade

2. Sibling's Full Name

Sibling's Gender

Male

Female

Sibling's Birth Date

Sibling's Current School

3. Sibling's Full Name

Sibling's Gender

Male

Famale

Sibling's Birth Date

Sibling's Grade

Sibling's Current School

Education

Current or most recent School (or daycare) attended

Current Grade

City

State

Zip/Postal

Dates attended

School District of Residence *

CCD15 (Palatine Residents)

Other

If "Other"

Public K-6 School Student would attend

Public Jr. High School Student would attend

Parishioner Status

Are you a St. Theresa Church Parishioner?*

Yes

Non-Catholic

Current Parish

Preschool Program Selection

Please indicate your preference in classes. We offer a variety of options and do our best to honor your requests upon admission.

Child must be 3 years old before September 1st of the school year. Please specify your choice of the morning or all-day program.

Preschool Program (3 years old)

Select the number of days.

Preschool 3 years old Program - Days

Must be 3 years old on or before September 1st to be eligible

2 Days (T/Th)

3 Days (M/W/F)

5 Days

Time

Morning Program (8:00 a.m. - 11:00 a.m.)

All-Day Program (8:00 a.m. - 2:00 p.m)

Preschool Program (4 years old)

Select the number of days.

Preschool 4 years old Program - Days

2 Days (T/Th)

3 Days (M/W/F)

5 Days

Time

Morning Program (8:00 a.m. - 11:00 a.m.)

All-Day Program (8:00 a.m. - 2:00 p.m)

Transportation*

Bus service is available for students within district 15 boundaries.

Bus Rider

Car Rider

Classrooms for Siblings/Multiples

Together

Separate

Parent/Guardian signature*

Date*

Submissions:

The following are required as part of the Admissions process and should be uploaded, mailed or e-mailed to Terri Kolbus, Admissions office: tkolbus@sttheresaschool.com

Non-refundable $30 application fee per student
Transfer of Records (grades 2-8 only)
A copy of Birth Certificate
A copy of Baptismal/Sacramental documents (only if applicable)
Enrollment Confirmation/Consent Form (applies to students of parents who are separated/divorced)

Submission Uploads

Choose a file or drag it here.

ST. Theresa SchoolPreschool - 8th Grade

Please fix the highlighted areas below before submitting.

STS Admissions Application

Applicant Information

Family Information

Sibling Information

Parishioner Status

Preschool Program Selection

Preschool Program (3 years old)

Preschool Program (4 years old)