Reitz Memorial High School Application

Legal Name:*
First Middle Last
Preferred First Name:
Gender:*
Date of Birth:*
Date Format: MM slash DD slash YYYY
City and State of Birth:*
Applying for enrollment in grade:*
- 9
- 10
- 11
- 12
Current School*
Current School City, State, Zip:*
Previous schools the applicant has attended:
School Name Dates of Enrollment City, State, Zip
Student's Primary Address:*
Street Address Address Line 2 City State ZIP Code

No Post Office Box numbers
If Catholic, at what Parish are you registered?
Ethnicity:
- Hispanic/Latino
- Non-Hispanic/Latino
Race:
- American Indian or Alaskan Native
- Black or African American
- Asian
- Hispanic
- White
- Multi-racial
- Native Hawaiian or Pacific Islander

Check all that apply:
- Mother is deceased
- Father is deceased
- Parents are separated/divorced
Student lives with:*
Father/Guardian Information
Father's Name:*
First Last
Father's Email:
Father's Phone Number:
Father's Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

(If different from the student)
Name of Step-Mother:
First Last
(if applicable)
Mother/ Guardian Information
Mother's Name:*
First Last
Mother's Email:
Mother's Phone Number:
Mother's Address:
Street Address Address Line 2 City State ZIP Code

(If different from the student)
Name of Step-Father:
First Last
(if applicable)
Please list any siblings of the applicant.
Name Grade Current School
Please list the names of any RMHS graduates in the applicant's family.
Name Class Year Relationship

This application for admission has been completed in its entirety by a parent or legal guardian. I give permission for Reitz Memorial High School to contact my student's current school, or past schools, for the purpose of completing the admission process. This would include, but not limited to, information regarding attendance, academic progress, discipline, and tuition status. I also understand that a $100, non-refundable, deposit is required to complete my student's application for admission.*
- I agree to the following:
I will submit the $100, non-refundable deposit, which will be applied to tuition and fees, to complete the application process through:*
Application Submitted By:*

Application for Admission

School Name	Dates of Enrollment	City, State, Zip

Name	Grade	Current School

Name	Class Year	Relationship