St Theresa School

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

Applicant Information

Academic Year

Kindergarten

Morning

All Day

Before or After School Care

Morning

Afternoon

Both

Student name *

LAST, FIRST, MIDDLE

Nickname

Date of Birth *

MM/DD/YYYY

Place of birth*

(city, state or country)

Address

Street Address*

City*

State*

Zip/Postal*

How did you hear about St. Theresa School?

Website

Social Media

Friend

Church

Sign

Other:

If "Other"

Religion*

Baptism*

Yes

Communion*

Yes

If applicable, please submit a copy of the relevant certificate with your application.

Languages spoken at home*

Medical Conditions we should be aware of?*

Yes

Allergies

If yes, please explain:

Family Information

Home Phone*

Area Code and Phone Number

Mother's Name / Guardian *

LAST, FIRST

Email*

Cell Phone*

Employer

Work Phone

Occupation

Marital Status

Father's Name / Guardian *

LAST, FIRST

Email*

Cell Phone*

Employer

Work Phone

Occupation

Marital Status

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

Gender

Male

Female

Birth Date

Grade

Current School

2. Sibling's Full Name

Gender

Male

Female

Birth Date

Current School

3. Sibling's Full Name

Gender

Male

Famale

Birth Date

Grade

Current School

Education

School

Current Grade

City

State

Zip/Postal

Dates attended

School's phone

School District of Residence *

CCD15

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 1 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.

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)

Extended Day Care

Mornings

Afternoons

Both

Preschool Program (4 years old)

Select the number of days.

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)

Extended Day Care

Mornings

Afternoons

Both

Transportation*

Bus service is availble for students within the district boundaries.

Bus Rider

Car Rider

Classrooms for Siblings/Multiples

Together

Separate

Parent/Guardian signature*

Date*

Parent/Guardian signature

Date

Submission

Non-refundable $25 application fee per student is enclosed.

A copy of the most recent report card is enclosed (grades 2-8 only).

A copy of Birth Certificate is enclosed.

A copy of Baptismal/Sacramental documents are enclosed (if applicable).

Admission Process

Please email a copy of the child's birth certificate and baptismal certificate (if applicable) to tkolbus@sttheresaschool.com

A one time application fee of $25 per student should be written and mailed to St. Theresa School 445 N. Benton St., Palatine, IL 60067

Please email a copy of the most recent report card (grades 2-8 only) to tkolbus@sttheresaschool.com

If you have any questions, please contact the Director of Admissions, Terri Kolbus at tkolbus@sttheresaschool.com.

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.

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)

Admission Process