Cantwell-Sacred Heart of Mary High School

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

CSHM Online Application
Thank you for your interest in CSHM.
Please complete the form below. Mandatory fields are marked*If you are using a coupon code, you must select the bubble next to the $50 fee in order for the code to be applied.

Application Fee

$50.00

Coupon Code

Total: $0.00

General Information

Student First Name: *

Student Last Name: *

Student Middle Name: *

Gender: *

Grade Entering: *

Present School: *

Date of Birth: *

(mm/dd/yyyy)

Place of Birth: *

Primary Language Spoken At Home: *

Date Application Submitted: *

Home Address

Street Address: *

City: *

State: *

Zip Code: *

Home Phone #: *

Cell #:

Email Address:

Student Information

Student Lives With: *

Guardian (specify):

Student Religion:

Parish/Church:

City of Parish:

Student's Ethnic Category:

(for statistical purposes only)

Other:

AT LEAST ONE OF THE THREE INFORMATION BLOCKS BELOW MUST BE FILLED IN:

Mother Information

Mother's Full Name:

Street Address:

City:

State:

Zip Code:

Home Phone #:

Cell #:

Email:

Name of Company:

Profession & Position:

Work Phone:

Father Information

Father's Full Name:

Street Address:

City:

State:

Zip Code:

Home Phone #:

Cell #:

Email:

Name of Company:

Profession & Position:

Work Phone:

Step-parent/Guardian's Full Name

Guardian Full Name:

Street Address:

City:

State:

Zip Code:

Home Phone #:

Cell #:

Email:

Name of Company:

Profession & Position:

Work Phone:

Please List Alumni Siblings/Relatives and Class Year

Siblings/Relatives and Class Year:

Signature: *(mother or father signature is required)

As parent or guardian, I accept responsibility for timely payment of tuition and fees, and I understand they are nonrefundable. As parent or guardian or student, I attest that all information is true and to the best of my knowledge. I also realize that if accepted to this High School I become responsible for reading, understanding, supporting, and abiding by all policies outlines and explained in the Parent/Student Handbook, distributed at the beginning of each new school year.

Mother or Guardian's Signature:

Enter First and Last name

Father or Guardian's Signature:

Enter First and Last name

Student's Signature: *

Enter First and Last name

Billing Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2: