Request Admissions Information Student Information First Name* First Last Name* Last Preferred Name Suffix Date of Birth* Date Format: MM slash DD slash YYYY Gender Grade 8th Grade9th Grade10th Grade11th Grade Current School* Current School* Home Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parent Information Parent/Guardian #1 Name* First Last Parent/Guardian #1 Email* Parent/Guardian #1 Preferred Phone Number* Parent/Guardian #2 Name First Last Parent/Guardian #2 Email Parent/Guardian #2 Preferred Phone Number Legacy Information Does the student have a relative (mother, father, sister, brother, aunt, uncle, or cousin) who is a graduate of Purcell Marian High School?* Yes No If yes, please provide name(s) Student Areas of Interest Check all that apply Check all that apply International Baccalaureate American Sign Language Baseball Basketball Campus Ministry Career Initiatives Program Cavalier Scholars Program Cheerleading Cross Country English Football Global Experiences History Math Music Science Service Spanish Soccer Softball Swimming Track & Field Visual Arts Volleyball Wrestling CAPTCHA
