St. Anastasia Catholic School

629 Glen Flora Avenue, Waukegan, IL 60085

Admissions Application 2021-2022

Please complete the form below. Mandatory fields marked *

APPLICANT INFORMATION

Please complete one form for each child applying. Thank you.

Applying for Grade:* Academic Year:*
Before or After School Care Needed: Yes No
Student First Name:* Student Last Name:*
Gender: Male Female
Date of Birth:*
Home Address:*
City:* State:* Zip:*

FAMILY INFORMATION

Home Phone:*

Father's Name/Guardian:*
Cell Phone:* Email:
Father's Occupation:
Employer: Work Phone:
Father's Ethnicity: American Indian/Alaskan Asian Bi-Racial Caucasian Black/African American Hispanic/Latino
Native Hawaiian/Pacific Islander

Mother's Name/Guardian:*
Cell Phone:* Email:
Mother's Occupation:
Employer: Work Phone:
Mother's Ethnicity: American Indian/Alaskan Asian Bi-Racial Caucasian Black/African American Hispanic/Latino
Native Hawaiian/Pacific Islander

Is your family Catholic?
Father: Yes No
Is your family Catholic?
Mother: Yes No
Are you a registered member of St. Anastasia Parish? Yes No
Church Env. #:
If no, what church do you regularly attend?
Home Public School District:*

PREVIOUS SCHOOL/DAYCARE INFORMATION

Current School/Daycare:
Dates Attended:
School's Address:
Reason for Leaving:

EDUCATIONAL HISTORY & QUESTIONNAIRE

Has your child had educational support or therapy of any kind? Yes No
If yes, please explain:
Has your child ever received an educational/psychological evaluation? Yes No
If yes, please explain:
Does a specialist provide services for your child? Yes No
If yes, please explain:
Why do you want your child to attend St. Anastasia Catholic School?:

FOR PARENTS WITH STUDENTS TRANSFERREING INTO GRADES 1-8

What are your child's personal and/or academic strengths?
How do you see St. Annie's being a good fit for your child?
How do you see St. Annie's being a good fit for your child?
If there was one area you would like your child to improve in, what would it be?
Is there any other information you would like us to know about your child?

SUBMISSION

Before being accepted into St. Anastasia, a copy of the following must be submitted to the school:

A copy of the most recent report card and standardized test scores are enclosed (grades 1-8, only)
A copy of Birth Certificate
A copy of Baptismal/Sacraental documents (if applicable)

Parent/Guardian signature:* Date:*

PRESCHOOL PROGRAM SELECTION

Please indicate your preference in classes.

We offer a variety of options and do our best to honor your requests upon admission.

Child must be 3 years old before September 1 of the school year.

PRESCHOOL PROGRAM - 3 YEARS OLD: PRESCHOOL PROGRAM - 3 YEARS OLD
TIME: Morning Program (8:00 a.m. - 11:00 a.m.) All-Day Program (8:00 a.m. - 2:45 p.m.)

PRESCHOOL PROGRAM - 4 YEARS OLD: PRESCHOOL PROGRAM - 4 YEARS OLD
TIME: Morning Program (8:00 a.m. - 11:00 a.m.) All-Day Program (8:00 a.m. - 2:45 p.m.)