Saint Augustine Academy

FAMILY ADMISSION QUESTIONNAIRE

(Please use Sibling Questionnaire for additional applicants)
Application Fee of $50.00 per child

Date:___________________________________
School
Applying for Grade _____ Year _____________

Applicant's Name____________________________________________________________________________
Last
First
Middle
Preferred Name__________________________

Phone No. (___)_________________________________

Home Address______________________________________________________________________________
Street
City
State
Zip
__________________________________________________________________________________________
Date of Birth
Age
Place of Birth
Country of Citizenship
__________________________________________________________________________________________
Native Language
Religious Preference
Parish or Church
__________________________________________________________________________________________
Date of Baptism
Date of First Communion
Date of Confirmation
How did you learn about St. Augustine Academy?_________________________________________________
__________________________________________________________________________________________
FAMILY INFORMATION

Fathers E-MAIL:_______________________________________
Mothers E-MAIL:______________________________________

Are both parents living?_______ Are parents divorced?_______ Separated?_______ Remarried?_______

Does applicant live with both parents?_______ Mother_______ Father_______ Guardian_______
Is he/she adopted?___ Do other adults live at home?___ Names and Role_______________________________
Father's Name

Work or Cell Phone (___) __________

Home Address (if diff. from above)_________________________________Religious Preference_____________

Place of work_______________________________________________ Work Phone (___)_________________
Work address______________________________________________ Position or Title___________________
College(s) attended_________________________________________

Degree(s)________________________

__________________________________________________________________________________________

Mailing Address: P.O. Box 4506, Ventura, CA 93007

130 South Wells Road, Ventura CA 93004 (805)672-0411 Fax (805)672-2365
www.SaintAugustineAcademy.com e-mail StAugAcad@juno.com
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Saint Augustine Academy

Fathers hobbies or special interests:
(Including musical, dramatic, athletic, computer, crafts, etc.)

Mothers Name____________________Maiden Name____________Work or Cell Phone(_____)

Home Address (if diff. from above)_________________________________Religious Preference
Place of work__________________________________________________ Work Phone (___)
Work address___________________________________________________Position or Title
College(s) attended______________________________________________Degree(s)

Mothers hobbies or special interests:

(Including musical, dramatic, athletic, computer, crafts, etc.)

Names and Ages of Siblings

School Currently Attending

VOLUNTEER WORK:
Please list present and past involvement in diocesan, parish, apostolic or civic groups with which you have donated your
time.

SCHOOL HISTORY
List names of schools applicant has attended. (An official transcript will be necessary before high school admission.)
If applicant has been home-schooled, please list length of time, grade levels and curricula used.
School

Location

Attendance Dates

Mailing Address: P.O. Box 4506, Ventura, CA 93007

130 South Wells Road, Ventura CA 93004 (805)672-0411 Fax (805)672-2365
www.SaintAugustineAcademy.com e-mail StAugAcad@juno.com
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Saint Augustine Academy

Has applicant ever skipped a grade?_____ If so, what grade?_____ Repeated a grade?_____ If so, what grade?
Does the applicant have any diagnosed physical or learning disabilities?_____ If yes, please describe:

Has he/she had academic problems?___ If so, in what areas?

If you are transferring, why do you wish to transfer?
MEDICAL INFORMATION
(A medical examination and certificate signed by the doctor are required before enrollment.)
Does applicant suffer from any specific health conditions that we should be aware of?
Please explain:
Does he/she require any special attention?
Is he/she currently taking any medication?____If so, what kind?
Has applicant ever had an operation?___ If so, what and at what age?
Has he/she ever had a serious injury?____If so, what and at what age?
Has applicant stayed home from school repeatedly or for long periods due to illness?
Please explain:
Has applicant ever received special attention or evaluation from a psychologist, therapist or counselor?
If so, please list date, name and address of consultants and describe situation briefly.

PARENT QUESTIONNAIRE
In order for us to get to know you and your child better, please answer the following questions:
What would you say are your child's main assets, qualities, strengths and talents (academically, socially, physically,
and/or morally)?

What do you expect from us and from your child(ren) at St. Augustine?

Mailing Address: P.O. Box 4506, Ventura, CA 93007

130 South Wells Road, Ventura CA 93004 (805)672-0411 Fax (805)672-2365
www.SaintAugustineAcademy.com e-mail StAugAcad@juno.com
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Saint Augustine Academy

What kinds of activities do you enjoy doing together as a family?

What kind of discipline/reward system do you practice at home?

********************************************************************************************
I hereby certify that all information provided on this application and all information given to St. Augustine Academy, is complete and accurate, and I
understand that falsification or omission of information may result in disqualification or dismissal.
Furthermore, I understand that all information submitted to St. Augustine Academy is confidential and that the Director of Admissions may disclose,
for official purposes, any information received from the applicant according to his discretion.

Parents' or guardians' signatures:

Date:

____________________________________________________________________________________________
____________________________________________________________________________________________

Checklist: Requirements for Admission

We must receive the following items WITH this
form in order to consider your application.
___Completed Application Form
___Copy of Birth Certificate
___ Application and Testing fee of $50.00
___Immunization Records

Checklist: Additional Documents Needed

OFFICE USE ONLY:
These items can be submitted following submission ofAccepted:
initial application forms:
Not Accepted:
___ Medical examination statement from doctor
App. Fee Pd.
___ Copy of Baptismal Certificate
Date
Ck.#
___ Copies of any report cards or Standard Tests
___ Letter of recommendation for children entering Comments:
grade 7 or above.
entering 7th, 8th and 9th grades

Comments:

Mailing Address: P.O. Box 4506, Ventura, CA 93007

130 South Wells Road, Ventura CA 93004 (805)672-0411 Fax (805)672-2365
www.SaintAugustineAcademy.com e-mail StAugAcad@juno.com
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Saint Augustine Academy

STUDENT QUESTIONNAIRE (Optional for Lower School Students, K-3)
What hobbies, sports, and activities do you most enjoy outside of school?
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

What is your favorite academic subject and why?

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Please describe an event that has had a special impact or significance in your life?
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

SUDENT ESSAY: Grades 4-12 Applicants - (Please neatly handwrite on a separate sheet of lined paper.)
Why do you want to come to St. Augustine Academy?
C:\Documents and Settings\User\My Documents\Admissions\Application for Admission.doc

Mailing Address: P.O. Box 4506, Ventura, CA 93007

130 South Wells Road, Ventura CA 93004 (805)672-0411 Fax (805)672-2365
www.SaintAugustineAcademy.com e-mail StAugAcad@juno.com
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