HFCHS-Applicationtransfer

Transportation Request

Busing Options *

I live in District 112 and my child will need busing.
I do not need District 112 busing.
I live outside of District 112 and would be interested in transportation provided by Holy Family for a fee.

Short Answer

For the student to complete

Why would you like to attend Holy Family Catholic High School?

Parent Responses

Name of Parent Completing *
Are you interested in learning more about our need-based tuition assistance? *	Yes No
To assist us in getting to know your student's needs right away, is there anything you'd like us to know? (Optional)

Mother/Guardian 1 Information

Name
Custodial Parent?	Y N
Spouse's Name
Address Street
City/State/Zip
Home Phone	( ) -
Cell Phone	( ) -
Work Phone	( ) - x
Employer
Occupation
Email

Father/Guardian 2 Information

Name
Custodial Parent?	Y N
Spouse's Name
Address Street
City/State/Zip
Home Phone	( ) -
Cell Phone	( ) -
Work Phone	( ) - x
Employer
Occupation
Email

Grandparent Information

Please share grandparent information so we may invite them to special events (i.e. Grandparents Day) and send our quarterly magazine, Passages.

Maternal Grandparents
MG Home Address Street
City/State/Zip

Maternal Grandparents Email
Paternal Grandparents
PG Home Address Street
City/State/Zip
Paternal Grandparents Email

Consent To Release Private Data

Authorization: I authorize HOLY FAMILY CATHOLIC HIGH SCHOOL to obtain information from the school listed above.

The information to be released:
• Official School Records (e.g., name, address, attendance record, grades, test results, behavior)
• Standardized Testing Results
• Health Records
• Psychological Records
• Social Work Reports
• Current School Counselor Observations
• Chemical Abuse/Dependency Report
• Medical Reports (including related services)
• Special Education Results (including related services)

I understand that student records may be examined by parent/guardian(s) or the student if age 18 or older. I understand that this authorization takes effect the day I sign it. I understand I may change or revoke this authorization at any time. This authorization expires one year from the date of my application submission.

Effective Date of Release *	Yes, I release my child's records effective today. No, please request my child's records at the end of the school year. I understand this may delay final acceptance.
Use your mouse on desktop or finger on phone or tablet to sign	Use your mouse or touchscreen to create your handwritten signature.

Student Legal First Name *
Student Middle Name *
Student Last Name *
Student Suffix (Jr, III, etc...)
Student Informal Name *

Student Address * Street
City/State/Zip
Date of Birth *
Student Home Phone *	( ) -
Student Email optional
Gender *	M F
School Year Enrolling *	2019-2020 2020-2021
Grade Enrolling In *	9 10 11 12
School Attended in 2018-2019 *
School Address * Street
City/State/Zip
Public School District in Which You Reside *
Religion *
Parish/Church *
Ethnic Affiliation (for statistical purposes only)	Asian-Pacific Islander Caucasian Latino/Hispanic Native American African American Multiracial (please identify)
Student Resides with *	Parents Mother Father Guardians Mother & Stepfather Father & Stepmother Other (please explain)
Student Interests and Hobbies *

Sibling Name
Current Grade 2019-2020
Current School
Gender	M F

Sibling Name
Current Grade 2019-2020
Current School
Gender	M F

Sibling Name
Current Grade 2019-2020
Current School
Gender	M F

Sibling Name
Current Grade 2019-2020
Current School
Gender	M F

Duplicate Mailings name of person to send duplicate mailings to
Address Street
City/State/Zip

How did you learn about enrolling opportunities at Holy Family? *	Family Website Open House Friend Neighbor Realtor Magazine School Parish Facebook Twitter Newspaper Article Other (please explain)

Transfer Student Application