Reitz Memorial High School Application for Admissions

Legal Name:*
First Middle Last
Preferred First Name:
Gender:*
Date of Birth:*
Date Format: MM slash DD slash YYYY
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:*
No Post Office Box numbers

Street Address Address Line 2 City State ZIP Code
If Catholic, at what Parish are you registered?
Ethnicity:*
Required for state reporting
- Hispanic/Latino
- Non-Hispanic/Latino
Race:*
Required for state reporting
- 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

The following documents need to be uploaded and are required for admissions:
Most Recent Report Card*
Drop files here or
Attendance Record (if not included on report card)
Drop files here or
Disciplinary Record (if not included on report record)
Drop files here or
Most Recent IEP, ISP, CSEP, or 504 plan (if applicable)
Drop files here or
Immunization Records*
State law requires that all students provide documentation of immunizations. The documentation must include the student’s name and date of birth, and the vaccine given and date (month/day/year) of each immunization.
Drop files here or
Birth Certificate (if not from an eastside partner school)
The following schools are considered eastside partner schools: Annunciation at Christ the King, Annunciation at Holy Spirit, Good Shepherd, Holy Rosary, St. Benedict, and St. John the Baptist.
Drop files here or
Custody Agreement (if applicable)
Drop files here or

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 agree to the following:
Application Submitted By:*

Application for Admission

School Name	Dates of Enrollment	City, State, Zip

Name	Grade	Current School

Name	Class Year	Relationship