Mercy High School

Student Information

Name

First

Middle

Last

Suffix

Preferred Name

Current School

Current School (if you previously indicated OTHER)

Current Grade

Applying For Grade

To begin in Fall of/academic year

Primary Contact Parent and Guardian Information

Relationship to Student

Name

Title

First

Last

Suffix

Preferred Name

Mailing Address

Phone

Type

Number

Alternate Phone

Type

Number

Email

Interests

Do you play on a club or travel team?

Yes No

Please list the sport(s) and name(s) of the team(s) and the number of years that you have played.

Fine Arts/Performing Arts Interests: please select your top 2 interests

Do you participate in any outside Fine Arts Groups? (e.g. Peabody, Twigs, Dance studio, theatre group

Yes No

Please list those group(s) and the number of years that you have been involved.

Additional Interests: please indicate any other interests

Are you interested in our Sister Michelle Carroll Learning Services Program?

Yes No

This program offers Mercy Girls with documented learning differences or mild to moderate language-based learning disabilities a highly personalized program in a challenging and inclusive academic setting, preparing them to be successful and confident learners in high school, college, and beyond.

How did you hear about Mercy High School?

Requested hostess, if known (current Mercy freshman or sophomore):

First

Last

Alumnae Information

Do you have any alumnae connections?

Yes No

Name

Graduation Year

Additional Notes