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Notre dame preparatory

NOTRE DAME PREPARATORY
9701 E. Bell Rd., Scottsdale, AZ 85260 Phone: (480) 634-8200 Fax: (480) 634-8299
2011-2012
A P P L I C A T I O N F O R M
(Please Print Clearly or Type) Entering Grade: ______________
STUDENT INFORMATION
Student’s Primary Street Address □ Multi-Racial (please specify)___________ Student’s Religion/ Denomination □ Married □ Divorced □ Separated □ Single □ Widowed Complete this Section if Parents are Divorced:  Father is remarried  Mother is remarried Student lives with:  Mother  Father  Shared  Guardian If not joint custody, legal custody has been granted to:  Mother  Father Legal documentation of birth parents regarding custody/visiting rights MUST be supplied. PARENT/GUARDIAN INFORMATION
(In case of joint custody, please complete a separate application form for each custodial household.)
Area Code & Home Phone Number Area Code & Home Phone Number Area Code & Cell Phone Number Area Code & Cell Phone Number Area Code & Work Phone Number Area Code & Work Phone Number Brothers & Sisters: Name Age Grade School Attending NDP Alumni (Yes or No) PARENT/GUARDIAN:
What special circumstances that Notre Dame should be aware of have affected the applicant’s school performance, i.e., physical handicaps, illnesses,
learning difficulties, frequent changes of home or school?
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
MEDICAL INFORMATION (Please print)

1.
Is the student taking any medications on a regular basis (i.e., insulin, Dilantin, Ritalin, etc.)? If yes, please explain:____________________________________________________________________________________________________________ 2. Has your student had any history of drug abuse? If yes, please explain:____________________________________________________________________________________________________________ 3. Does the student have any disabilities that Notre Dame should be aware (i.e., allergies, asthma, epilepsy, eye or ear problems, learning disabilities), or are there any limitations on normal activities? If yes, please explain:____________________________________________________________________________________________________________
ACADEMIC INFORMATION
Schools student has attended in the past three years:
School:_______________________________________________________________________________
Address:______________________________________________________________________________________________________________________ School:_______________________________________________________________________________ Address:______________________________________________________________________________________________________________________ Has the student ever repeated a grade, skipped a grade, or received accelerated instruction?
If yes, please explain circumstances:________________________________________________________________________________________________
______________________________________________________________________________________________________________________________

A NON-REFUNDABLE APPLICATION FEE OF $50 is payable with this application.


For Office Use Only Interview Date:___________________________________________________ Assigned to:___________________________________________________ Application Complete:_____________________________________________ Acceptance Code:_______________________________________________

Source: http://www.notredamepreparatory.org/pdf/Admissions/App%20Pack%202011-2012/Application%20for%20Admissions%20form%20from%20DW%209-14-09-tyTake2.pdf

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