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Student Information

Please note: a $50 application fee is collected when submitting your application.

Date of Application*

Student Name*

First Middle Last

Student Gender*

Birthdate*

Birth Certificate Upload

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 10 MB, Max. files: 2.

Please upload your child's birth certificate

Grade applying for:*

Birthplace*

City State Country

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Home Phone (If Applicable)*

Cell Phone

Email Address*

Current School Now Attending*

Current Grade*

School Address*

Street Address City State ZIP / Postal Code

Sacramental Information

Baptism Date

Church Name

Church Address

Street Address City State ZIP / Postal Code

Baptism Certificate

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 5 MB, Max. files: 3.

Please upload your child's baptism certificate

1st Penance Date

Church Name

Church Address

Street Address City State ZIP / Postal Code

1st Communion Date

Church Name

Church Address

Street Address City State ZIP / Postal Code

First Communion Certificate

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 5 MB, Max. files: 2.

Please check where applicable:*

Catholic

non-Catholic

Do you attend Mass regularly?*

Yes

Registered in Our Lady of Lourdes Parish?*

Yes

Sunday Envelope Number

Please list ways you have been active in Our Lady of Lourdes Parish*

Parish

If not registered in this parish, please indicate the parish where you reside

Name of Parish*

City*

Family Information

Not applicable

Check here if not applicable (e.g. single parent)

Father's Name*

First Middle Last

Father's Email*

Cell Phone

Work Phone

Father's Birthplace*

Father's Religion*

Father's Occupation*

Father's Employer*

Father's Marital Status*

Is the last name different from the applicant's last name?*

Yes

If name is different from applicant's, what name is used?*

Not applicable

Check here if not applicable (e.g. single parent)

Mother's Name*

First Middle Maiden

Mother's Email*

Cell Phone

Work Phone

Maiden Name

Mother's Birthplace*

Mother's Religion*

Mother's Occupation*

Mother's Employer

Mother's Marital Status*

Is the last name different from the applicant's last name?*

Yes

If name is different from applicant's, what name is used?*

Are the child's parents divorced?*

Yes

If divorced, who has legal custody of the applicant*

Not applicable

Check here if not applicable (e.g. single parent)

Guardian's Name*

First Middle Last

Guardian's Birthplace*

Guardian's Religion*

Guardian's Occupation*

Guardian's Marital Status*

Is the last name different from the applicant's last name?*

Yes

If name is different from applicant's, what name is used?*

Parent/Guardian Questionnaire

Child Applicant's Name*

First Last

Nickname*

Entering Grade*

Birth Date*

Present Age*

Religious Education Attendance*

Yes

Has your child attended Catholic school previously?*

Yes

Where is that?*

If so, how long did he/she attend?*

How did you hear about Our Lady of Lourdes? Did a current school family refer you? If so, which family?

Previous School(s)

Previous School(s) attended: (If school attended was Catholic, please asterisk).

Name of School

From

Name of School

From

Name of School

From

Upload 2 Years of Report Cards and Standardized Test Results

Please upload the last 2 years of the student's report cards and standardized testing.

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 5 MB.

Why do you want your child to attend Lourdes?*

Where do you plan to apply if you are not accepted at Lourdes?*

Please add any information that might be pertinent in helping us evaluate this application.*

How do you plan to contribute your time and talent to the Lourdes Community?*

Family Education History

Not applicable

Check here if not applicable (e.g. single parent)

Father's Elementary School

Father's High School

Father's College

Not applicable

Check here if not applicable (e.g. single parent)

Mother's Elementary School

Mother's High School

Mother's College

Any other family background information that you would like to add

Payment

We collect a $50 application fee for each application.

Application Fee

Price:

How would you like to make your payment?

Credit Card/Debit Card

ACH/Bank Draft

Billing Name*

First Last

Receipt Email*

Total

Credit Card*

Bank Details*

Student Information

Sacramental Information

Parish

Family Information

Parent/Guardian Questionnaire

Previous School(s)

Family Education History

Payment

Our Lady of Lourdes Parish School

18437 Superior Street Northridge, CA 91325

(818) 349-0245

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