| Grade Applying For |
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| Academic Program |
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| Current School | |
| Applicant First Name | |
| Applicant Middle Name | |
| Applicant Last Name | |
| Applicant Preferred Name | |
| Birthday (XX/XX/XXXX) | |
| Sex |
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| Address | |
| City | |
| State | |
| ZIP Code | |
| Phone (XXX-XXX-XXXX) | |
| Family Email | |
| Religious Affiliation/Parish, if Catholic | |
| Race/Ethnicity |
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| Schools Previously Attended, Most Recent First | |
| If transferring from another high school, reason for transfer | |
| Is applicant a sibling of a current SBA student? |
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| Is applicant a sibling of an Auburndale/SBA graduate? |
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| If yes, year of graduation | |
| Are parents divorced or seperated? | |
| If so, who has legal custody? | |
| Student Lives With: |
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| Father's Name | |
| Employer | |
| Work Phone | |
| Cell Phone | |
| Religious Affiliation | |
| Auburndale/SBA Graduate? |
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| Mother's Name | |
| Employer | |
| Work Phone | |
| Cell Phone | |
| Religious Affiliation | |
| Auburndale/SBA Graduate? |
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| The applicant's home address is the primary mailing address and all school mailings will be mailed to this address. If information should be mailed to a different address, please provide. | |
| Student Interests (check all): |
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| Has applicant ever experienced academic problems resulting in the reptition of a grade or dismissal from school? |
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| If yes, please explain: | |
| Has applicant ever been suspended/expelled or asked to withdraw from school due to disciplinary problems? |
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| If yes, please explain: | |
| Has applicant ever been involved in the use or sale of illegal drugs? |
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| If yes, please explain: | |
| Has applicant ever been treated for problems related to drugs, alcohol, or mental depression? |
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| If yes, please explain: | |
| Has applicant ever been diagnosed with any learning disorders or diabilities? | |
| If yes, please explain: | |
| Has applicant had any previous evaluation/testing that would help in determing placement? |
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| Please upload a copy of this evaluation with application. | |
| How did you learn about St. Benedict at Auburndale? |
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| INCOMING 9TH ONLY - 2011 High School Placement Test Reservation: I would like to register my child for the following date: |
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| Parent/Guardian Agreement: I understand that if my child is accepted to St. Benedict at Auburndale, he/she will be subject to the rules and regulations stated in the admissions information and school handbook which are revised annually. I futher understand that I will be financially responsible for the fees and tuition stated therein. | |