New Student Registration Application

- ADMISSIONS

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- Student Name (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.
- Birth Date REQUIRED Please fill out this field. Please enter a date.
- School Year REQUIRED Please fill out this field.
- Entering Grade Level REQUIRED Please fill out this field.
- Preschool or Kindergarten Selection
- Catholic Parish or Other Place of Worship Please enter valid data.
- Our family is not Catholic We might be interested in becoming Catholic We are not interested in becoming Catholic at this time
- Country of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Religion Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Primary Email Address REQUIRED Please fill out this field. Please enter valid data.
- Current School Please enter valid data.
- Public School District of Residence REQUIRED Please fill out this field. Please enter valid data.
- County REQUIRED Please fill out this field. Please enter valid data.
- Student Ethnicity REQUIRED Please fill out this field.
- Student Race REQUIRED Please fill out this field.
- Mother/Guardian's Name Please enter valid data.
- Religion Please enter valid data.
- Country of Birth Please enter valid data.
- Father/Guardian's Name Please enter valid data.
- Religion Please enter valid data.
- Country of Birth Please enter valid data.
- Parents/Guardians are REQUIRED Married Separated* Divorced* Single Deceased-Mother Deceased-Father Please fill out this field.
- *Custody papers must be submitted when you visit the school to complete the registration process.
- Home Situation of Student (check all that apply) REQUIRED 2 Biological Parents 1 Parent/Guardian Father/Stepmother Mother/Stepfather Other Please fill out this field.
- Please list stepparents, guardians, or addresses of parents if different from what is already listed. Please enter valid data.
- Street Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Phone Number Please enter a phone number.
- Please List Other Siblings (Name, Date of Birth, Grade if in School) Please enter valid data.
- Sacramental Information for Registering Student (if applicable)
- Baptism (Date, Church, City, State) Please enter valid data.
- First Penance (Date, Church, City, State) Please enter valid data.
- First Eucharist (Date, Church, City, State) Please enter valid data.
- Confirmation (Date, Church, City, State) Please enter valid data.
- Has your child been been given or referred for an educational evaluation? REQUIRED Please fill out this field.
- Does your child receive services such as speech, physical therapy, or occupational therapy? REQUIRED Please fill out this field.
- *If yes, please list services. Please enter valid data.
- Does your child have a current ER (Educational Report)? REQUIRED Please fill out this field.
- Does your child have an IEP (Individualized Education Program)? REQUIRED Please fill out this field.
- Does your child have a 504 Plan? REQUIRED Please fill out this field.
- *If your child has an ER, IEP or 504 Plan, please submit a copy when you visit the school to complete the registration process.
- Additional Comments
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Supporting Registration Documents
To complete the registration process, please gather other required documents (listed below) and contact Jenn Appaneal at advancement@simonandjude.org to make an appointment. Please note, new families are also required to set-up a FACTS account for your registration fee and tuition payments (instructions below).

REQUIRED DOCUMENTS
- PreK registration: CLICK HERE to download required documents.
- K-grade 8 registration: CLICK HERE to download required documents.
- Record of most recent physical examination and immunizations or you can use the PA Physician’s Report (filled out and provided by physician). CLICK HERE to download from school website.
- K-grade 8 students: PA Dentist Report (filled out by dentist). CLICK HERE to download from school website.
- Original Birth Certificate
- Original Baptismal Certificate (if applicable)
FACTS ACCOUNT INSTRUCTIONS FOR NEW FAMILIES
To pay the registration fee and set up your tuition schedule, please CLICK HERE to go to the school’s FACTS page. New school families should create a new account and follow instructions to enroll in a payment plan. Please note, if you wish to apply for financial aid, you will complete an application through FACTS.