MOTHER DR. MRS. MS. FULL NAME HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE OCCUPATION TITLE EMPLOYER FATHER DR. MR. FIRST NAME LAST NAME MIDDLE NAME MALE FEMALE Grades K School Year Required for Kindergarten - Grade 8 Please submit form with application fee APPLICANT (STUDENT) INFORMATION DATE OF BIRTH (MM/DD/YYYY)GRADE LEVEL FOR FAMILY INFORMATION APPLICATION FOR REGISTRATION & ENROLLMENT AGREEMENT SAINT JOSEPH SCHOOL A Higher Standard All information must be completely filled-in before accepted NICKNAME (IF PREFERRED) FULL NAME HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE OCCUPATION TITLE EMPLOYER PARENTS ARE MARRIED AND LIVING TOGETHER PARENTS ARE SEPARATED MOTHER IS REMARRIED NAME OF STEPFATHER PARENTS ARE DIVORCED SINGLE PARENT FATHER IS REMARRIED NAME OF STEPMOTHER GUARDIAN (if applicable) FULL NAME RELATIONSHIP TO APPLICANT HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE RETURNING STUDENT NEW STUDENT WITH WHOM DOES THE STUDENT PRIMARILY RESIDE? (CHECK ALL THAT APPLY) MOTHER FATHERLEGAL GUARDIAN OTHER (PLEASE EXPLAIN ) HOME STREET CITY STATE ZIP RACE / ETHNICITY: AFRICAN AMERICAN/BLACK ASIAN AMERICAN CAUCASIAN/WHITE LATINO/HISPANIC MULTIRACIAL NATIVE AMERICAN PACIFIC ISLANDER OTHER RELIGION: CATHOLICNON-CATHOLIC WILL THE STUDENT BE A BUS RIDER? YESNO WHAT PUBLIC SCHOOL BUILDING WOULD THE STUDENT ATTEND IF THEY WERE NOT ENROLLED AT SAINT JOSEPH SCHOOL (FOR EXAMPLE: NORD, POWERS, ETC.)? WHAT PUBLIC SCHOOL DISTRICT WOULD THE STUDENT ATTEND IF THEY WERE NOT ENROLLED AT SAINT JOSEPH SCHOOL? HOW DID YOU FIRST HEAR ABOUT SAINT JOSEPH SCHOOL AND WHAT LED TO YOUR DECISION TO CHOOSE SAINT JOSEPH SCHOOL AS THE PLACE OF EDUCATION FOR YOUR CHILDREN? REFFERAL: * *a copy of the divorce decree pertaining to the child must be on file in the school MARITAL STATUS: (CHECK ALL THAT APPLY)

PARISHIONER STATUS 175 Saint Joseph Drive Amherst, OH [p] (440) [f] (440) SAINT JOSEPH SCHOOL A Higher Standard SCHOOL OFFICE TUITION Please select one: ACTIVE PARISHIONER OF SAINT JOSEPH PARISH Membership: Registration is the first step to becoming an active and participating parishioner of Saint Joseph Parish. Being active includes 1) Will participate at Mass every Sunday and holyday of obligation. We will give evidence of our being present by using our Sunday Offertory envelopes every week, whether full or empty. 2)Participate in at least one ministry in our Parish, whether within the school itself or within the Parish at large. 3)Will regularly contribute financially to support our Parish according to the way we have been blessed. If we are not already tithing, we will work towards this goal. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE NON PARISHIONER / NON-ACTIVE PARISHIONER ENVELOPE NUMBER As a non-parishioner or a non-active parishioner of Saint Joseph Parish, I will support the school by teaching my child(ren) Christian values and the importance of belonging to a Christian community. I/We pledge to be current with our financial obligation to Saint Joseph School. I/We also agree to support Saint Joseph School through active participation with school programs, special events and special school needs. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE CHURCH OR PARISH RELIGION PERSON RESPONSIBLE FOR TUITION PAYMENTS? CHECK ALL THAT APPLY MOTHER FATHERLEGAL GUARDIAN FULL NAME RELATIONSHIP TO APPLICANT HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE OTHER (IF “OTHER”, PLEASE COMPLETE THE SECTION BELOW) Please return this completed form and the Early Bird $50 non-refundable application fee for each student to be enrolled for the school year before January 28th 2016 at 3:30p.m. EST. Following January 28th 2016, the fee will be the regular price of $75. Academic Fees are including in Tuition rate(IMPORTANT: All blanks on all sides of this form must be filled in or application and registration fee will be returned.) TUITION REFUND POLICY The first tuition payment for the school year is due July 1, If a child is withdrawn from the school prior to the first day of class, 75% of tuition paid will be refunded. If a child is withdrawn within the first week (5 school days) of school, 40% of tuition paid will be refunded. No tuition payments will be refunded after the first week (5 school days) of school. Any job change causing a family relocation will be handled on an individual basis. (Initial that you read and understand the TUITION REFUND POLICY) PAYMENT PLAN (CHOOSE ONE) FULL PAYMENT (3% discount if received by July 15th, 2016) MONTHLY PAYMENT PLAN (11 monthly payments beginning July 1st, Payments due no later than the 10th of every month. These payments can be made thru on-line giving thru your checking account or your bank with automatic payment withdrawal. A $10 late fee is charged for payments received after the 10th of the month.) COST Tuition cost per pupil is $4, ($ monthly July 2016 – May 2017 without Parish Scholarship for the school year.) FINANCIAL ASSISTANCE The following types of financial assistance are available, please check the boxes that pertain to you. I/We plan to apply for the EdChoice Scholarship / EdChoice Expansion and agree to pay the $75 non-refundable registration fee. (You may need to complete a separate form, please check with the School Office.) I/We are registered parishioners of Saint Joseph Parish and would like to be considered for a parish scholarship. I/We plan to apply for additional financial assistance through our own church or parish. Name of Church or Parish: I/We plan to apply for additional financial assistance by submitting the PSAS (Private School Aid Service) – see the school office for more info. (Must re-apply yearly) I/We choose not to accept financial assistance and will pay the full tuition amount of $ 4,500. CHECK # FOR OFFICE USE ONLY REGISTRATION FEE EARLY BIRD: $50 IF RECEIVED ON/BEFORE JANUARY 28 TH 2016; $75 AFTER AMOUNT RECEIVED NOTES FEES TOTAL AMOUNT RECEIVED: All FEES ARE NON-REFUNDABLE CASH