Please complete the following form:

    
 FIRST NAME                    MIDDLE NAME                          LAST NAME                    

ADDRESS                                                         CITY                         TX        ZIP CODE

DATE OF BIRTH (mm/dd/yy)      E-MAIL ADDRESS

PRESENT SCHOOL ATTENDING                                   CURRENT GRADE  APPLYING GRADE

 PARISH 


FATHER'S FIRST NAME    MIDDLE NAME                           LAST NAME

                       
MOTHER'S FIRST NAME   MIDDLE NAME                           LAST NAME             

                                   
  HOME PHONE NUMBER       FATHER'S WORK NUMBER     MOTHER'S WORK NUMBER   

  FATHER'S E-MAIL                    MOTHER'S E-MAIL        

 
  FATHER'S ALTERNATE/CELL     MOTHER'S ALTERNATE/CELL

With whom does the student live?  
(e.g., mother and father, father, mother, stepfather, stepmother, grandparents,
legal guardian)

With whom should correspondence and billing information be sent? 
(Please provide address if different from above)

Has applicant ever skipped or repeated a grade? YES  NO  (If YES please explain below):

Has applicant ever been dismissed, suspended or denied readmission from any school 
for any reason? YES  NO  (If YES please explain below):

Has applicant ever consulted with a professional for testing or guidance?
YES  NO  (If YES please explain below):

Have any of your relatives attended Providence in the past? YES  NO 
If yes, please list the name(s):

Do you have any relatives currently attending Providence? YES   NO
If yes, please list the name(s):

The Admissions Office will be requesting the following information from your present school:

To submit this form click on the "Submit Form" below.