STS Admissions Application

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

Answer Required

Kindergarten

Answer Required

Morning (7:40 - 12:00)

All Day

Before or After School Care

Answer Required

Morning

Afternoon

Both

Unsure

Student name *

LAST, FIRST, MIDDLE

Answer Required

Nickname

Answer Required

Date of Birth *

MM/DD/YYYY

Answer Required

Place of birth*

(city, state or country) Please scan birth certificate

Answer Required

Is the student Hispanic or Latino?*

Answer Required

Yes

What is the student's race?

check all that apply

Answer Required

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)

Answer Required

Primary Address

Street Address*

Answer Required

City*

Answer Required

State*

Answer Required

Zip/Postal*

Answer Required

If "Other"

Answer Required

Religion

Answer Required

If Catholic, was your child Baptized?

Answer Required

Yes

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

Answer Required

Communion

Answer Required

Yes

Languages spoken at home*

Answer Required

Medical Conditions or Allergies we should be aware of?*

Answer Required

Yes

Please list Allergies or Medical conditions (if applicable)

Answer Required

Family Information

Home Phone

Area Code and Phone Number

Answer Required

Mother's Name / Guardian *

LAST, FIRST

Answer Required

Email*

Answer Required

Cell Phone*

Answer Required

Employer

Answer Required

Work Phone

Answer Required

Occupation

Answer Required

Marital Status*

married, separated, divorced, single

Answer Required

Father's Name / Guardian *

LAST, FIRST

Answer Required

Email*

Answer Required

Cell Phone*

Answer Required

Employer

Answer Required

Work Phone

Answer Required

Occupation

Answer Required

Marital Status*

married, separated, divorced, single

Answer Required

Student Lives with:*

Answer Required

Both

Mother

Father

Other:

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

Answer Required

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

Answer Required

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

Answer Required

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

Answer Required

Yes

Sibling Information

Is Applicant oldest or only child?*

Answer Required

Yes

1. Sibling's Full Name (if applicable)

Answer Required

Gender

Answer Required

Male

Female

Sibling's Birth Date

Answer Required

Siblings Current School and Grade

Answer Required

2. Sibling's Full Name

Answer Required

Sibling's Gender

Answer Required

Male

Female

Sibling's Birth Date

Answer Required

Sibling's Current School

Answer Required

3. Sibling's Full Name

Answer Required

Sibling's Gender

Answer Required

Male

Famale

Sibling's Birth Date

Answer Required

Sibling's Grade

Answer Required

Sibling's Current School

Answer Required

Education

Current or most recent School (or daycare) attended

Answer Required

Current Grade

Answer Required

City

Answer Required

State

Answer Required

Zip/Postal

Answer Required

Dates attended

Answer Required

School District of Residence *

Answer Required

CCD15 (Palatine Residents)

Other

If "Other"

Answer Required

Public K-6 School Student would attend

Answer Required

Public Jr. High School Student would attend

Answer Required

Parishioner Status

Are you a St. Theresa Church Parishioner?*

Answer Required

Yes

Non-Catholic

Current Parish

Answer Required

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

Answer Required

2 Days (T/Th)

3 Days (M/W/F)

5 Days

Time

Answer Required

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

Answer Required

2 Days (T/Th)

3 Days (M/W/F)

5 Days

Time

Answer Required

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.

Answer Required

Bus Rider

Car Rider

Classrooms for Siblings/Multiples

Answer Required

Together

Separate

Parent/Guardian signature*

Answer Required

Date*

Answer Required

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

Answer Required

Choose a file or drag it here.

ST. Theresa SchoolPreschool - 8th Grade

Please fix the highlighted areas below before submitting.

Applicant Information

Family Information

Sibling Information

Parishioner Status

Preschool Program Selection

Preschool Program (3 years old)

Preschool Program (4 years old)