Application for 2021-2022 School Year

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School Name: St. Raymond Elementary School
School Year: September 2021-June 2022
Application Fee
Date of Application REQUIRED Please fill out this field. Please enter a date.
Grade Applying for (not for UPK) REQUIRED Please fill out this field. Please enter valid data.
Birth Certificate # Please enter valid data.
Child's Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address & Apt. # REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Please fill out this field.
- Religion Please enter valid data.
- Parish Please enter valid data.
- Who does child reside with? REQUIRED Please fill out this field. Please enter valid data.
- Relationship to child? REQUIRED Please fill out this field. Please enter valid data.
Mother's Information
- Mother: Single Married Separated Divorced Deceased
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address & Apt. # REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Religion Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Job Title REQUIRED Please fill out this field. Please enter valid data.
- Employer's Name REQUIRED Please fill out this field. Please enter valid data.
- Work Phone Number REQUIRED Please fill out this field. Please enter valid data.
Father's Information
- Father: Single Married Separated Divorced Deceased
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address & Apt. # REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Religion Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Job Title REQUIRED Please fill out this field. Please enter valid data.
- Employer's Name REQUIRED Please fill out this field. Please enter valid data.
- Work Phone Number REQUIRED Please fill out this field. Please enter valid data.
Custody or Guardianship of Child
- Custody of Child (if applicable)
- Custodial Parent Please enter valid data.
- Relationship Please enter valid data.
- Documentation Provided Please enter valid data.
- Date Please enter valid data.
- Guardianship of Child (if applicable)
- Guardian Please enter valid data.
- Relationship to child Please enter valid data.
- Documentation Provided Please enter valid data.
- Date Please enter valid data.
Sacraments
- Baptism (certificate required)
- Date Please enter a date.
- Church Please enter valid data.
- Location Please enter valid data.
- Reconciliation
- Date Please enter a date.
- Church Please enter valid data.
- Location Please enter valid data.
- First Holy Communion
- Date Please enter a date.
- Church Please enter valid data.
- Location Please enter valid data.
- Confirmation
- Date Please enter a date.
- Church Please enter valid data.
- Location Please enter valid data.
Child's Education
If your child has attended more than 1 school previously, please select the up arrow on the field below "Previous School Attended" to add additional fields to the form for that information:

If you child has not previously attended any school, please write "none" underneath Previous School 1.If your child was home schooled, please write "home schooled" underneath Previous School 1.
- Previous Schools Attended REQUIRED Please fill out this field.
- Previous School 1
  - School Name REQUIRED Please fill out this field. Please enter valid data.
  - School Address Please enter valid data.
  - Grades Completed Please enter valid data.
  - Dates Attended Please enter valid data.
- Previous School 2
  - School Name REQUIRED Please fill out this field. Please enter valid data.
  - School Address Please enter valid data.
  - Grades Completed Please enter valid data.
  - Dates Attended Please enter valid data.
- Previous School 3
  - School Name REQUIRED Please fill out this field. Please enter valid data.
  - School Address Please enter valid data.
  - Grades Completed Please enter valid data.
  - Dates Attended Please enter valid data.
Has child been evaluated by the district Committee on Special Education? REQUIRED Yes No Please fill out this field.
Has child been evaluated by a private psychological or educational agency? REQUIRED Yes No Please fill out this field.
If answer to either or both statements above is YES, applicant must complete the following:
Type of Evaluation Educational Psychological Speech Other
Educational Evaluation Please enter valid data.
Date of Evaluation Please enter a date.
Name of Agency Please enter valid data.
Contact Name and Phone Please enter valid data.
Psychological Evaluation Please enter valid data.
Date of Evaluation Please enter a date.
Name of Agency Please enter valid data.
Contact Name and Phone Please enter valid data.
Speech Evaluation Please enter valid data.
Date of Evaluation Please enter a date.
Name of Agency Please enter valid data.
Contact Name and Phone Please enter valid data.
Other Evaluation Please enter valid data.
Date of Evaluation Please enter a date.
Name of Agency Please enter valid data.
Contact Name and Phone Please enter valid data.
If child has been seen by the public district Committee on Special Education, applicant must complete the following:
1. Was an IEP ever generated? Yes No
2. Child has a Section 504 Accommodation Plan? Yes No
District Name and # Please enter valid data.
Date of Most Recent IEP Please enter valid data.
Date of Last Psychological Evaluation Please enter a date.
Classification and Recommended Placement Please enter valid data.
How did you hear about our school? (Please check all that apply.) REQUIRED Bronx Penny Pincher Bronx Times Reporter Bronx Riverdale Family Magazine Caribbean Life El Correo Postcard Mailer Google Search Live in the Area News 12 Niche.com Parish Bulletin School Website Word of Mouth Other Please fill out this field.
If other, please indicate here. Please enter valid data.
I affirm that the above information is true to the best of my knowledge. I understand that failure to provide the required documentation stops the application process. Furthermore, should my child be accepted/admitted under false, incomplete, or negligent information, my child will be dismissed from the school. I also agree that should my child be accepted/admitted, my child and I will be bound by the terms and conditions of the school's parent/student handbook, including those provisions referencing inoculations. Final acceptance of this application is dependent on all outstanding fees being paid in full to any previous school(s). Acceptance notices will be mailed.
I Affirm Please select this field.
Signature of Parent or Guardian REQUIRED Please fill out this field. Please enter valid data.
Date REQUIRED Please fill out this field. Please enter a date.

Submit

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St. Raymond Elementary School
2380 East Tremont Avenue Bronx, NY 10462 718-597-3232 Fax 718-892-4449	Eugene Scanlon - Principal Fr. James Cruz - Pastor

Application for 2021-2022 School Year

Custody of Child (if applicable)

Guardianship of Child (if applicable)

Baptism (certificate required)

Reconciliation

First Holy Communion

Confirmation

Child's Education

If answer to either or both statements above is YES, applicant must complete the following:

If child has been seen by the public district Committee on Special Education, applicant must complete the following:

St. Raymond Elementary School