APPLICATION FOR ADMISSION

                                                                          Date of Application  ____________

                                                                          Grade Entering  _______________

                                                                          Referred by __________________

Child’s Name ______________________________________________________

Address _____________________________ City  ______________  Zip  ______

Telephone __________________/__________________/__________________

                             (Home)                      (Work-Father)                    (Work-Mother)

Date of Birth ______________________  Age ____________     Sex  _________

Last School Attended _______________________________   Grade  _________

Father’s Full Name     _______________________     Marital Status   __________

Mother’s Full Name     ______________________      Marital Status   __________

Occupation/Place of Business    ___________________ / ___________________

                                                           (Father)                                   (Mother)

How should your mail be addressed? ____________________________________

                                               ____________________________________

Non-Refundable Application Fee Enclosed  ($25.00)      Check  ____   Money Order  ____  Cash  ____

DIVERSITY:

Mount St. Joseph Academy is among the most diverse independent private schools in New York State.   We believe that our diverse backgrounds enrich the fabric of our community.

NOTICE OF NONDISCRIMINATORY POLICY:

Mount St. Joseph Academy admits students of any race, color, national origin, and ethnic origin to all the rights privileges, programs, and activities generally accorded or made available to students at the school    It does not discriminate on the basis of race, color, national origin, and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and other school administered programs.

At Mount St. Joseph Academy, our diversity is our strength.