Student Information Student's Legal Name Last First Middle Baptismal Name (if the student has one: Please provide a copy of the student's birth certificate as soon as possible. You may hand-carry it to your admissions interview, or email it to: Barbara@OrthodoxSchoolReno.com, or attach it in this form: Student's Gender: MaleFemale Date of Birth: Place of Birth: Age: Address: City: State: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip: Preferred Phone Number(s): Most Recent School: Grade (as of 9/2018): Has the student been Baptized and/or Chrismated into the Orthodox faith YesNo If yes, where? Date: Priest's Name: Does your family attend religious services? YesNo If so, where? Other Education Please provide prior academic records (such as your child?s last report card), if available, at your admissions interview. Where? When? Reason for leaving? Parent Information Parent 1 Parent 1 Name: Home Phone: Cell Phone: Work Phone: Religious Background: Custodial?YesNo Parent 2 Parent 2 Name: Home Phone: Cell Phone: Work Phone: Religious Background: Custodial?YesNo If there are additional stepparents or guardians, please provide this information at your admissions interview. Other Caretakers (e.g., nanny, babysitter, grandparent) Please include names and telephone number(s): Siblings Name: Grade: Age: School Special Needs If your child has special needs, we will ask you to help us serve your child better by completing a Special Needs Information Form at the time of your admissions interview. Financial Assistance Do you anticipate needing tuition scholarship assistance?YesNo If yes, we will discuss our partial and full scholarship programs with you at your admissions interview. Exempt Private School Information St. Nicholas Orthodox Academy is operated as an exempt private school under the provision of NRS 394.211 and as such is exempt from the provisions of the Private Elementary and Secondary Education Authorization Act. Your name: Your e-mail: