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STUDENT APPLICATION AND INFORMATION FORM 2026-207

YEAR

Applying for:

State

City

Please select your student status:

Domestic Student (U.S. Citizen or Permanent Resident)International Student (Visa Holder or Non-U.S. Citizen)

Grades 6-12 Boys & Girls

Commuters StudentsDormant Students

Applicant

Middle Name

Last Name

Today's Date:

First Name

Date of Birth:

Social Security Number;

Gender:

Birthplace:

Native Language:

Citizen of:

Present Grade:

Applying for Grade:

In School Grade:

Home Number:

Cell Phone:

Present School

School Phone

School Address

Parent/Guardian 1 Information :

Name:

Home Address:

Email Address:

Cell Phone:

Home Phone:

Bus Phone:

Employer:

Years there:

Poaition:

Bus Address:

Parent/Guardian 2 Information

Name:

Email Address:

Cell Phone:

Home Phone:

Employer:

Years there:

Position:

Bus. Address:

If parents are separated or divorced, to whom shall we send the following?

EMERGENCY CONTACT INFORMATION

In the event of an emergency, please contact the following person(s):

1.Name:

Relationship:

Address:

City:

State:

Zip:

Cell Phone:

Home Phone:

Bus. Phone:

2.Name:

Relationship:

Address:

City:

State:

Zip:

Cell phone:

Home Cell:

Bus.Phone :

Medical Contact Information:

Doctor's Name:

Phone:

Allergies, Medical Conditon, etc.

BELOW THIS FORM YOU WILL FIND AN AUTHORIZATION FOR OFFICIAL RECORDS FOR YOU TO COMPLETE AND FOR US TO SEND TO YOUR CHILD’S PRESENT SCHOOL. DURING THE INTERIM, WE ASK THAT YOU CONTACT YOUR CHILD’S PRESENT SCHOOL AND OBTAIN UNOFFICIAL RECORDS AND GIVE THEM TO US IMMEDIATELY. WE WILL USE THESE RECORDS UNTIL WE RECEIVE THE OFFICIAL RECORDS.

I certify that the information provided in this application is true, accurate, and complete. I also certify that I have not omitted any information relevant to the assessment of my child’s application for admission.

Parent/Guardian Signature:

Date:

AUTHORIZATION FOR OFFICIAL RECORD

Parents/Guardians: Please complete this form and submit it with the Student Application. Subsequently, we will send this form to your child’s school to request an official transcript and other official records.

Principal:

Name of School:

School's Complete Address:

School's Telephone Number:

The full academic information is requested for the student named below:

· Current academic year report card with at least one marking period grades reported

Previous year’s full transcript
All standardized testing results
Health Records
Discipline reports
Attendance record
A copy of any IEP, 504, Title I special services received

Student Name:

Present Grade:

Parent/Gaurdian Name:

Parent/Gaurdian:

Date:

Please send materials to:

The Patrick School
Centenary University Campus

Hackettstown NJ 07840

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Contact Information

STUDENT APPLICATION AND INFORMATION FORM 2026-207

Parent/Guardian 1 Information :

Parent/Guardian 2 Information

If parents are separated or divorced, to whom shall we send the following?

EMERGENCY CONTACT INFORMATION In the event of an emergency, please contact the following person(s):

Medical Contact Information:

AUTHORIZATION FOR OFFICIAL RECORD

Please send materials to: The Patrick SchoolCentenary University Campus Hackettstown NJ 07840

EMERGENCY CONTACT INFORMATION

In the event of an emergency, please contact the following person(s):

Please send materials to:

The Patrick School
Centenary University Campus

Hackettstown NJ 07840