St. Valentine Entrance Inquiry

Student Information

Legal Name (First, Last)
Preferred Name/Nickname
Mailing Address
Phone number
Date of Birth
GenderMale Female
Grade applying to enter
Current school
Faith Affiliation
Parish/Church
Siblings who have attended
St. Valentine School

Parent/Guardian Information

Father's Name
Father's Mailing Address
Father's Phone
Father's E-Mail Address
Mother's Name
Mother's Mailing Address
Mother's Phone
Mother's E-Mail Address
Guardian's Name(s)
Guardian's Mailing Address
Guardian's Phone
Guardian's E-Mail Address

How did you hear about St. Valentine School?
Please check all that apply

Newspaper (Which? )
Magazine (Which? )
Radio station (Which station? )
Billboard (Where? )
Referral (Who? )
Other (Please specify )

What are you most interested in learning about St. Valentine School?
Please check all that apply

Academics Gifted/Talented Programs
Accreditation Special Needs Programs
After/Before School Programs Teacher Qualifications
Athletics Technology
Curriculum Test scores
Extracurricular Activities Transportation
Tuition Assistance 

What additional information do you need about St. Valentine School before you can make a decision about enrolling?

What is the best day/time and method (phone, e-mail or regular mail) to follow up with you?

Day(s): Time(s):
Phone    E-Mail    Regular Mail

What other educational options are you considering in addition to St. Valentine School?

Public school    Charter School    Private School
Other Catholic school    Homeschool

Would you like us to provide you with scholarship and other financial aid options available at St. Valentine School?

Yes    No

Thank you for your interest in St. Valentine School