Web Student Inquiry Form Question Title * 1. School Year 2013 - 2014 2014 - 2015 2015 - 2016 2016 - 2017 2017 - 2018 2018 - 2019 Question Title * 2. Student Last Name First Name Middle Name Question Title * 3. Home Address Street/Apt. # City State Zip Question Title * 4. Date of Birth (MM/DD/YYYY) Question Title * 5. Home Phone Question Title * 6. Home Phone Type Landline Cell Phone Question Title * 7. Ethnicity Asian Black Filipino Hispanic Multiple White Other (please specify) Question Title * 8. Residency Status US Citizen US Permanent Resident Other (please specify) Question Title * 9. Current Grade 07 08 09 10 11 Question Title * 10. Current School Question Title * 11. Religious Affiliation Baptist Catholic Jewish Muslim None Other Christian Other (please specify) Question Title * 12. Parent Email Address Question Title * 13. Mother/Stepmother/Guardian Last Name First Name Question Title * 14. Father/Stepfather/Guardian Last Name First Name Question Title * 15. Parent Cell Phone Question Title * 16. Parent Work Phone Question Title * 17. Annual Household Income $38,000 or less From $38,000 to $43,740 From $43,741 to $58,320 From $58,321 to $72,900 From $72,901 to $87,480 From $87,481 to $102,060 Question Title * 18. Number of People in Household 2 3 4 5 6 7 More than 7 Question Title * 19. As a member of the National Cristo Rey Network, Verbum Dei's Corporate Work Study Program (CWSP) provides students with real world job experiences and allows them to earn a portion of the cost of their education. It is an integral part of their educational experience at Verbum Dei High School. A positive attitude and a commitment to high standards of responsibility and behavior are required. Due to the requirements of the Work Study Program, all applicants must be 14 years of age by September 1 of the school year. I certify that the applicant will be legally able to work in the US by the beginning of his freshman year. Yes Question Title * 20. Please send me the Admissions Application Packet in: English Spanish Done
