Parent/Guardian First Name *

Parent/Guardian Last Name *

Email Address *

Home Street Address *

City *

State *

Zip Code *

Primary Contact Phone Number *

Student First Name *

Student Last Name *

Student Birth Date *

Male or Female? *

Name of child's current school?

Current Grade Level *

Grade Level Interested *

Projected School Year of Entry *

What is your child's primary exceptionality?

Does your child have an IEP? *

Which Scholarship does your child currently have? *

If you are not eligible to receive the McKay Scholarship, have you filed for 'Step up for Students' scholarship?

How did your hear about St. Mary Academy? *

Do you have another child interested in our school? *