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Application Form
Fill out the information requested below, then submit online or print and mail to the address below.
Applications will
NOT
be reviewed until
ALL
items listed in the checklist have been received.
Note: All applicants must pay a $50.00 Application Fee. For incoming 9th graders, this fee includes the Entrance Exam Registration.
Applying for Grade
9th Grade (August)
9th Grade (January)
10th Grade
11th Grade
12th Grade
Last Name
First Name
Middle Name
Address
City
State
Zip
Phone
E-Mail Address
Social Security Number
Ethnicity (optional)
Gender
Male
Female
Date of Birth
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Place of Birth (city, state, country)
Have you ever been suspended or dismissed from any school?
Yes
No
If so, please explain circumstances
Present School
Applying for School Year
Religion
Name of Parish/Church
Father's Name
Father's Phone Numbers
Father's Address
Father's Employer
Mother's Name
Mother's Phone Numbers
Mother's Address
Mother's Employer
List the names and ages of any siblings living in your home
List the names of any close relatives who attend or have graduated from Chaminade, Madonna, or Chaminade-Madonna
Please list any learning disabilities
Describe your talents and interests and how they might contribute to the mission of Chaminade-Madonna. Include any activities in which you participate and/or any awards that you have won.
Briefly explain why you want to attend Chaminade-Madonna
How did you learn about Chaminade-Madonna?
Do you plan to attend college after completing high school?
Yes
No
Do you speak, read, or write in a foreign language?
Yes
No
If so, which?
I understand that Chaminade-Madonna will contact my current school to obtain information about my academic performance and overall conduct. By submitting this form, I verify that the information it contains is accurate and I authorize Chaminade-Madonna to request the necessary data from my current school.
Order Information
Description:
Chaminade-Madonna College Preparatory Admissions Application Fee
Total:
US $50.00
Payment Information
Credit Card Information
* Denotes Required Fields
Accept Credit Cards Online
Card Number:
*
(enter number without spaces or dashes)
Expiration Date:
*
(mmyy)
Card Code:
*
Three- or four-digit number on the back of a credit card (on front for American Express)
Billing Information
First Name:
*
Last Name:
*
Address:
*
City:
*
State/Province:
*
Zip/Postal Code:
*
Email:
*
Confirm Email:
*
Phone:
*
Please enter the words you see in the image.
What is this?
Or
Print and Mail to:
Admissions Director
Chaminade-Madonna College Preparatory
500 E Chaminade Drive
Hollywood, FL 33021