Application and Registration Form

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.

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

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: