STEP 1 - Application for Admission

Thank you for your interest in St. Theresa School.  Please complete all fields of the Application for Admission below.  
Please submit your application and supporting documentation** in your designated enrollment phase.  All applications will be verified for phase accuracy.  Applications received that do not qualify for that particular enrollment phase will be discarded and application fee refunded.  Forms cannot be submitted without payment verification.
 
**Supporting documentation and application fee may be mailed or dropped off at the school office during school office hours (M-F, 8:30am-3:30pm, unless noted otherwise on the school calendar).
 
Phase 1:  January 3, 2017 - January 13, 2017
Currently enrolled St. Theresa School students in good standing**
**This includes siblings of currently enrolled St. Theresa School students who re-enrolled for 2015-2016.
 
Phase 2:  January 17, 2017 - January 27, 2017
Parish families not currently enrolled at St. Theresa School**
 
**Families must be officially registered with St. Theresa Parish.  If you are unsure if you are registered, please contact the Parish Secretary.  To register with the Parish, you must live within St. Theresa Parish boundaries and complete an application form.  Parish registration will be verified prior to acceptance confirmation.
 
Phase 3:  January 30, 2017 - February 10, 2017
Families of other Catholic parishes without a school.
 
Phase 4:  February 6, 2017 - February 17, 2017
General Community
School Year: *

STUDENT DATA

Only child at this school? *
Oldest child at this school? *

PREVIOUS SCHOOLS ATTENDED

Had your child attended any previous schools? *
Please complete the following information for any previous schools your child has attended: *
 Name of SchoolDatesGradesCity/StateTelephone
School #1:
School #2:
School #3:

RELIGIOUS INFORMATION

Baptized? *
If Catholic, are you registered with St. Theresa Church? *
For Catholic applicants, please complete the following information: *
 Date (mm/dd/yyyy)ChurchCity and State
Baptism:
Reconciliation:
First Eucharist:
Confirmation:

FAMILY BACKGROUND INFORMATION

Please complete the following information for both Mother and Father.  *
 MotherFather
Full Name
Maiden Name
Country of Birth
Home Address
Home City
Home State
Home Zip
Home Phone
Cell Phone
Work Phone
Work Email
Occupation
Employer
Religion
Parish
Primary Language Spoken in Home
If the child lives with a Guardian, complete the Guardian's information as well.
Legal Documentation must accompany the application paperwork when submitted.
 *
 Guardian
Full Name
Maiden Name
Country of Birth
Home Address
Home City
Home State
Home Zip
Home Phone
Cell Phone
Work Phone
Work Email
Occupation
Employer
Religion
Parish
Primary Language Spoken in Home
Martial Status (check all that apply): (NOTE: In the event of a divorce, decree of custody must be filed in the school office, as well as any specific instructions regarding release of the child to a parent. *
Name and Address of person responsible for tuition/fees payment.
Grandparent Information:
 PaternalMaternal
Full Name
Home Address
Home City
Home State
Home Zip
Home Phone
Cell Phone

ADDITIONAL INFORMATION

Has your student ever been suspended, dismissed, expelled, or not permitted to re-enroll in a school? *
Has your student ever been tested or evaluated for any disability (i.e. Learning Disabilities, Attention Deficit (Hyperactivity) Disorder, Emotional Disabilities, etc.), English as a Second Language, or medical condition? *
To be considered for admission, the following documents, including a non-refundable application fee, must be delivered to the school office.
 
1.  Copy of Baptismal Certificate (Catholics only)
2.  Immunization record
3.  Copy of custody decree (if applicable)
4.  Copy of original birth certificate.
5.  Current report card including comments and the two previous academic years' report cards.
6.  Current standardized test scores plus the two previous years, if available.
7.  Scholastic Form completed by present teacher.
8.  A non-refundable application fee of $150

CERTIFICATION

I certify that all information provided and all statements made in all sections of this Application are true and correct to the best of my knowledge.

I understand that if I provide false information or withhold relevant information and it is discovered after my child has been registered at St. Theresa School, the offer of admission may be revoked.

St. Theresa School does not discriminate on the basis of race, national or ethnic origin in the administration of our educational policies, admission policies, athletic or other school administered programs.  All students have the rights, privileges, programs, and activities generally accorded or made available to all students formally accepted into the school.  Students in grades 1-8 are not formally accepted until completing a ninety day probationary period.  Children who are not Catholic are expected to participate in religion classes and to respectifully attend all religious functions of the school.

I agree and understand that my typed electronic signature below shall have the same legal effect as my original signature and is being accepted as my signature pursuant to the Virginia Uniform Electronic Transactions Act, Code of Virginia, 59.1-479 et seq.