Registration Form – St. Vivian Catholic School

Student Information

Name of Student *

First

Middle

Last

Nickname

Date of Birth *

Upload Birth Certificate

Click or drag a file to this area to upload.

Gender *

Religion *

Upload Baptismal Certificate

Click or drag a file to this area to upload.

Upload Certificate of First Reconciliation

Click or drag a file to this area to upload.

Upload Certificate of First Communion

Click or drag a file to this area to upload.

Upload Certificate of Confirmation

Click or drag a file to this area to upload.

Applying for Entry into Grade *

Public School District *

Public School Building (Name) *

Previous School Attended

Previous School Phone

Previous School Fax

Previous School Address

Address Line 1

Address Line 2

City

State

Zip Code

Upload Previous Report Card(s)

Click or drag a file to this area to upload.

Do you want to apply for bus service? *

Access the scholarship form here: https://online.factsmgt.com/signin/3XF84

Will you be applying for an Ohio EdChoice Scholarship? *

Access the scholarship form here: https://online.factsmgt.com/signin/3XF84

Which Program?

Access the scholarship form here:

https://online.factsmgt.com/signin/3XF84

Income eligibility guidelines:

http://education.ohio.gov/getattachment/Topics/Other-Resources/Scholarships/EdChoice-Scholarship-Program/FederalPovertyGuidelines.pdf

Family Information

Student Resides With *

Upload Court/Custody Documents

Click or drag files to this area to upload. You can upload up to 8 files.

Primary Guardian Name *

First

Last

Primary Guardian SSN *

If you do not have a SSN, please enter all 0's. You will be contacted by our Business Office to gather supporting documents. Not providing your SSN will delay your child's acceptance or push them to a waiting list.

Primary Guardian Relationship *

Primary Phone *

Primary Email *

Primary Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Occupation & Place of Employment *

Primary Work Phone

Secondary Guardian Name

First

Last

Secondary Guardian SSN

Secondary Guardian Relationship

Secondary Phone

Secondary Email

Secondary Address

Address Line 1

Address Line 2

City

State

Zip Code

Secondary Occupation & Place of Employment

Secondary Work Phone

Demographics

Hispanic? *

Ethnicity *

Primary Language *

Secondary Language

Academics

Has the student had any of the following academic testing/evaluations?

Upload Evaluation Documentation

Click or drag files to this area to upload. You can upload up to 10 files.

Has the student been enrolled in any special programs in or out of school?

Has the student

had/has IEP
Been Retained
Prescribed Medication

If you chose one or more options, please specify the area/give more detail below