St. Philip's Academy Online Application for Admission
	Please read:   It is difficult and sometimes impossible for us to receive Recommendation Forms and Transcript Requests from other schools during the summer months. If your student currently attends a public school please ensure to have all teacher recommendation forms completed at least one week prior to the schools closing. If the recommendation forms are not received in our office, your student’s file will be considered incomplete These items are a vital part of an applicant’s file and we will be unable to review a file if it is incomplete.

	Instructions: Please print clearly. A nonrefundable application fee of $35 must accompany this form and be made payable to St. Philip's Academy. A recent photograph of the student applying for admission should be clipped to this form or sent by email as an attachment to stodman@stphilipsacademy.org. This form may also be downloaded here. Name First:* Last:* Nickname: Grade Apply:*  Kindergarten  First  Second  Third  Fourth  Fifth  Sixth  Seventh  Eighth For the School Year Beginning September:* 2011 2012 2013 Current Grade:* Pre-K Kindergarten First Second Third Fourth Fifth Sixth Seventh Birthdate:* Gender:*  Male  Female Ethnicity African American Asian Caucasian Hispanic Multiracial Other SSN:* Place of Birth:* Country:* Citizen of Country* Home Address Street* City* State* Zip* Phone Number (Home)* Student Email Address Email* Previous Applications Has the applicant applied to St. Philip's Academy in the past?:*  Yes  No If Yes When? Special Circumstances Please list any special circumstances in your child’s life that should be brought to the attention of the school (serious illnesses/accidents in the family, absence of a parent, adoption, etc.): Financial Aid I wish to apply for financial aid:* Yes No Undecided All families interested in being considered for financial aid are required to complete the application process by April 30. SCHOOL INFORMATION Present School Present School:* Type of School Select one school type:*  Public  Private  Parochial  International  Other If Other Please Specify: Address of Present School Address Line 1:* Address Line 2:* City:* State/Province/Region:* Zip:* Country:* Phone Number of Present School Phone:* Years Enrolled Number of Years Enrolled at Present School:* Principal Name of Principal or Head of Present School:* Previous Schools Schools Previously Attended (Name, Address, Years Attended): FAMILY INFORMATION Parent 1 Information Parent 1 - Name Prefix: First:* Last:* Suffix: Parent 1 - Address (if different than student) Street: City: State: Zip: Citizenship Parent 1 is a Citizen of:* Parent 1 - Home Phone Number Home Phone:* Parent 1 - Cell Phone Number Cell Phone: Parent 1 -Email Address Email:* Parent 1 - Occupation Occupation:* Parent 1 - College College attended/year graduated: Parent 1 - Employer Employer: Employer's Address Street: City: State: Zip: Parent 1 - Work Phone Number Work Phone: Parent 1 - Work Fax Number Fax: Stepparent's Name (if applicable) First: Last: Parent 2 - Information Parent 2 - Name Prefix: First: Last: Suffix: Home Address (if different from above) Street: City: State: Zip: Citizen of Country: Parent 2 - Home Phone Number Home Phone: Parent 2 - Cell Phone Number Cell Phone: Parent 2 - Email Address Email: Parent 2 - Occupation Occupation: Parent 2 - College College attended/year graduated: Parent 2 - Employer Employer: Employer's Address Street: City: State: Zip: Parent 2 - Work Phone Number Work Phone: Parent 2 - Work Fax Number Fax: Stepmother's Name (if applicable) First: Last: Marital Status Status:* Select Option Married Divorced Separated Mother Deceased Father Deceased Together, Not Married Parents Not Married to Each Other Other Situation Custody If parents are divorced or separated, who has legal custody of the applicant?: Lives With Applicant Resides With (check all that apply):*  Father  Mother  Stepfather  Stepmother  Siblings (specify # below)  Other Persons (specify # below) Number of Siblings/Other Number of Siblings and/or Other Persons: Correspondence Correspondence Should Be Sent To: *  Both Parents  Father  Mother  Other (specify below) Other Other, and address if different from above: Bills and Fees Bills and Fees Should Be Sent To:*  Both Parents  Father  Mother  Other (specify below) Other Other, and address if different from above: Siblings Please list names of applicant’s brothers and sisters, their ages, schools (or colleges) they now attend, and grade/year in school: Relatives Please list any other relatives (not named above) who are attending or have attended St. Philip's Academy, with their name, dates of attendance, and relationship to applicant: How did you hear about St. Philip’s Academy? Referral From a family member or friend Media NJAIS NJ SEEDS Personal Research Signs or Banners Walk In List person or media item (if applicable) SIGNATURE AND PAYMENT A non-refundable application fee of $35 must be paid before processing your request. This may be paid by check and sent to: Admissions Office St. Philip's Academy 342 Central Avenue Newark, NJ 07103 You may also pay by credit card. Call (973) 624-0644 ext. 109 to speak with the business office to make a payment. Billing Address Street:* City:* State:* Zip:* Electronic Signature of Parent or Legal Guardian I hereby certify that the information on this application is true and correct to the best of my knowledge. I understand that any false statement or omission of any statement can be sufficient cause for rejection of my application. Prefix: First:* Last:* Suffix: Date Date:* Email Address Email:* Please Click the Submit Button Only Once.  It may take over a minute to process.