The Admissions Committee reviews each application individually, considering a combination of factors before making a decision. Please follow the appropriate procedures below to ensure the timely review of your child’s application:
Date of Application: 06/19/13
Applying for grade:
Academic year: 20- 20
Student Last Name:
Student First Name:
Current Address:
City:
State:
ZIP Code:
Telephone: - -
Date of Birth: / /
SSN: - -
Gender: Male
Female
Current Age in Years:
Place of Birth
Citizenship: USA / Other:
Permanent Resident Alien Card #:
*The Archdiocese of Miami is authorized under federal law to enroll nonimmigrant alien students and issue I-20 certificates in order for students to obtain F-1 status. If you need assistance please let the school know at registration.
Mother's Name:
Mother's address:
Same as Student
Home Phone: - -
Work Phone: - -
Cell Phone: - -
Email:
SSN:
Place of Employment:
Position:
Father's Name:
Father's address:
Same as Student
Home Phone: - -
Work Phone: - -
Cell Phone: - -
Email:
SSN:
Place of Employment:
Position:
Student Lives With: Parents
Mother
Father
Guardian:
Does student have any siblings attending Pace? Yes No
Sibling Name:
Grade:
Sibling Name:
Grade:
RELIGIOUS INFORMATION:
Catholic: Yes No
If yes, parish name:
If no, list other religion:
Unless you present proof of parish participation, the admissionso ffice will seek verification of your membership status.
DEMOGRAPHIC INFORMATION (FOR REPORTING PURPOSES ONLY):
Caucasian
Hispanic
Black
Asian/Pacific Islander
Native American
Other
Current Grade:
Current/Previous School:
Reason for leaving:
SCHOOLS PREVIOUSLY ATTENDED BY APPLICANT:
Name of School:
City:
Dates of Attendance:
Grade(s) Completed:
Name of School:
City:
Dates of Attendance:
Grade(s) Completed:
Has applicant ever failed a grade? Yes No
If yes, which grade(s)?
Has applicant ever been suspended? Yes No
If yes, please explain:
Has applicant ever been asked to withdraw? Yes No
If yes, please explain:
Has applicant ever been dismisssed or expelled? Yes No
If yes, please explain:
Has applicant ever been convicted of a:
Misdemeanor? Yes No
Felony? Yes No
Drug abuse/Possession?? Yes No
If you answered yes to any of the above questions, please provide further details below.
Is it your intention to have your child graduate from Monsignor Pace High School? Yes No
If not, please explain:
Has the applicant taken the Catholic High School Entrance Exam: Yes No
If yes, please indicate:
Where:
When:
Has the applicant ever been tested for a learning disability: Yes* No
*If yes, please provide a copy of the initial evaluation and I.E.P
Please list any medical conditions/ medications of which the school should be made aware of that relates to your child:
Physician Name:
Phone: - -
In the event the student is accepted and enrolled in school, please list the names of all persons authorized to pick-up your child during school hours:
Name:
Name:
Name:
Name:
If you have further information which may assist in the guidance of your child at Monsignor Pace High School, such as pertinent medical or other data the school should be aware of, please indicate below:
PARENT/GARDIAN STATEMENT:
In making an application for my child to attend Monsignor Pace High School, I agree to support the spiritual, moral, and disciplinary standards of the school as outlined in the student handbook. Given the mission of the school as an agent of Christian formation, the school will accept only those children whose parents, understanding the Catholic nature of the school, demonstrate a desire that their children participate in the Catholic pedagogy of the school, whether the family is Catholic or not.
I agree to assume the responsibility for my child’s education by supervising assigned homework and maintaining regular contact with my child’s teachers.
I agree to support the school to the best of my ability by attending and participating in the various activities of the school.
I understand that my compliance is required in the regular payment of tuition, fees, stewardship, fundraising, and other financial obligations as outlined in the approved payment schedule. I further understand that non-compliance may result in the dismissal of the student, the non-issuance of examinations, and the withholding of all records until payment is complete.
In the event my child becomes ill or is injured while under school supervision, I approve the school authorities taking the following steps:
1. Contact a parent of the student and follow his/her instructions
2. Contact the student’s physician and follow his/her instructions
3. Use their own discretion in contacting a properly licensed physician and follow his/her instructions if the student's physician cannot be reached.
If, in the opinion of a properly licensed physician, my child needs medical or surgical services which required my consent before being supplied, and I cannot be reached, I hereby authorize, appoint, and empower the principal or his/her designee, to furnish on my behalf such written or oral authorization as may be so required. Further, I release the principal, or his/her designee, and Monsignor Pace High School from any liability which might arise from the giving of such authorization, it being by desire that my child be furnished with such medical or surgical services as soon as reasonably possible after the need arises.
The statements contained in this application are true to the best of my knowledge. I understand the misrepresentation or omissions of facts called for on this application, when discovered by school authorities, may be cause for dismissal or non-acceptance of the applicant at the will and complete discretion of Monsignor Pace High School.
I hereby authorize Monsignor Pace High School to make inquiries and obtain my child’s academic, disciplinary, attendance, and health records from schools in which my child has been in attendance.
IMPORTANT: The school collects directory and demographic information for accreditation purposes. Periodically, students participate in opinion and interest surveys that may be used in school publications (i.e. newspaper, yearbook, etc.) Contact the school at 305-623-PACE if you do not want your child to participate in these activities.
Monsignor Pace High School admits students of any race, color, national or ethnic origin to all the rights, privileges, programs, and activities made available to students of the school. It does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational policies, admissions policies, scholarships, athletics, or any other school-administered programs.
I agree to these conditions* / Type Name Here*:
Date: 06/19/13
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