Please list all relatives who attend(s)/attended Cathedral Prep or Villa Maria Academy​. (Name, Relationship, Graduation Year)​​
Please list all younger siblings of the prospective student. (Name, Relationship, Current Grade Level)​​
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Why do you, the parents, want your son to attend Mother Teresa Academy?​​​
By typing my full name, I give permission for Mother Teresa Academy to request and receive all pertinent records from my son's current school of attendance.​​​​
Non-Discrimation Policy Statement: Although Mother Teresa Academy is distinctly Catholic school, it welcomes children of all backgrounds and does not discriminate against qualified student on the basis of race, color, religious creed, ancestry, national origin, disability, or age, as required by law, in the administration of its educational policies, admissions procedures, financial aid/scholarship rewards, and/or any other school administered programs.
Pennsylvania School Code 13-1304-A states in part: “Prior to admission to any school entity, the parent, guardian or other person having control or charge of student shall, upon registration, provide a sworn statement or affirmation stating whether the pupil was previously suspended or expelled from any public or private school of this Commonwealth or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person, or for any act of violence committed on school property.”
Has your child ever been previously suspended or expelled from any public or private school of the Commonwealth of Pennsylvania or any other state for an act or offense involving weapons, alcohol or drugs, or for the willful infliction of injury to another person or for any act of violence committed on school property.​​​
I understand that this form shall be maintained as part of the student’s disciplinary record. I further understand in making this statement that I am subject to penalties under 24 P.S. 13-1304-A9b) and 18 Pa.C.S.A.4904 relating to falsification to authorities, and that any willful false statement made on this form shall be a misdemeanor of the third degree. I swear or affirm that the facts contained herein are true and correct to the best of my knowledge, information and belief.​​

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