Application for Admission – Geibel Catholic

Prospective families for all grades, seventh through twelfth, can apply to Geibel Catholic Junior-Senior High School online using the form below. You may also download a paper application.

Please view the School and Technology Forms page to find additional applications and beginning-of-the-year forms.

If you have questions at any time, please don’t hesitate to contact the school office at 724-628-5600.

CAMPUS VISIT

Arrange for a campus visit by calling the school office at 724-628-5600. A visit may be scheduled prior to submitting an application or at any time during the admissions process.

APPLICATION OPTIONS

Online:
- Complete the application below.
- To save your progress, click the Save For Later button at the bottom.
- When finished, click the Submit button at the bottom. Upon successful submission, you will see a confirmation message.
Mail:
- If you prefer to complete a paper application, you can print and send your completed application to the school office at:
  Geibel Catholic Junior-Senior High School
  611 East Crawford Avenue
  Connellsville, PA 15425

Online Application for Admission

Save for Later and Submit buttons can be found at the bottom of the form.

APPLICANT INFORMATION

First Name(Required)

Middle Name(Required)

Last Name(Required)

Nickname

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone(Required)

Cell Phone

Date of Birth(Required)

Applying for Grade(Required)

Beginning September of (provide year)(Required)

Age as of September 1 of the specified year(Required)

Gender(Required)

Public School District (where you live)(Required)

Religion(Required)

Name and address of Catholic parish in which student is registered (if none or unsure, type N/A)(Required)

Has the applicant ever attended another Catholic School?(Required)

If yes, please list school and address

Race(Required)

Ethnicity(Required)

Does applicant have any special educational or medical needs?(Required)

If yes, please explain

PARENT/GUARDIAN INFORMATION

Parent/Guardian (1)

First Name(Required)

Middle Name

Last Name(Required)

Relation to Applicant(Required)

Religion(Required)

If Catholic, parish name and address where registered

Home Address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone

Email(Required)

Employer

Job Title

Work Address

Work Phone

Work Phone Extension (if applicable)

Parent/Guardian (2)

First Name

Middle Name

Last Name

Relation to Applicant

Religion

If Catholic, parish name and address where registered

Home Address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone

Employer

Job Title

Work Address

Work Phone

Work Phone Extension (if applicable)

Student resides with(Required)

If Guardian, please specify

Check all those that apply(Required)

Parents Married

Parents Not Married

Parents Separated

Parents Divorced

Father Remarried

Mother Remarried

Father Deceased

Mother Deceased

Single Parent Family

Are there any special custody circumstances?

CURRENT SCHOOL

Current School Name

Current School Phone

Current School Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date Entered

Current Grade Level

TUITION INFORMATION

Name of Individual Responsible for Tuition

Individual's Relation to Applicant

Individual's Address (if not a parent)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Individual's Phone

SACRAMENTAL INFORMATION

Baptism Date

Baptism Parish Name and Address

Reconciliation Date

Reconciliation Parish Name and Address

First Holy Communion Date

First Holy Communion Parish Name and Address

Confirmation Date

Confirmation Parish Name and Address

SIBLINGS

Sibling Name, Age, and School Attending:

RELATIVES

PLEASE LIST ANY RELATIVES WHO HAVE ATTENDED OR ARE NOW ATTENDING GEIBEL CATHOLIC JUNIOR-SENIOR HIGH SCHOOL.

Relative Name, Relationship, and Graduation Year:

Statement of Nondiscriminatory Acceptance Policy:

Geibel Catholic Junior-Senior High School will not discriminate on the basis of race, color, sex, disability, or national and/or ethnic origin. Students seeking acceptance and enrollment to the school will be considered based on religion, academic performance, learning needs, attendance, character, morality and conduct consistent with Catholic doctrine, and applicable payment history within a Catholic or private/nonpublic school. While the school does not discriminate against students with disabilities, a full range of services may not always be available to them. Decisions concerning the accommodation of a student are based upon the student’s emotional, academic, and physical abilities and the resources available to the school in meeting the student’s needs. The school maintains the right to give preferential acceptance and enrollment to Catholic students. The student is not permitted to attend this school if she or he has an outstanding payment balance at another Catholic School within the Diocese of Greensburg. Your signature below indicates that you understand and accept the content and provisions of this application.

Parent/Guardian (1) Signature(Required)

Parent/Guardian (1) Date Signed(Required)

Parent/Guardian (2) Signature

Parent/Guardian (2) Date Signed

PARENT QUESTIONNAIRE – ALL APPLICANTS

Parents or Guardians, The success of your child is important to us. Please complete the following questionnaire so that we may learn more about your child.

First name of person(s) completing this form:(Required)

Last name of person(s) completing this form:(Required)

Parent First Name(Required)

Parent Last Name(Required)

Parent's Relationship to Applicant(Required)

What factors contributed to the decision to apply to Geibel Catholic Junior-Senior High School?(Required)

How did you hear about us?(Required)

What words or phrases come to mind when describing your child?(Required)

Please comment on what you consider to be your child’s greatest strengths.(Required)

What do you hope your child will gain by attending Geibel Catholic Junior-Senior High School?(Required)

Please indicate any special circumstances that may have affected the educational progress of your child.(Required)

Parent Signature(Required)

Date Signed(Required)

STUDENT QUESTIONNAIRE – APPLICANTS ENTERING GRADES 7-12

STUDENT INSTRUCTIONS (students entering grades 7-12 only). Please take a moment to complete this questionnaire so we may learn more about you.

Student First Name

Student Middle Name

Student Last Name

Student Applying for Grade

What is your favorite subject or activity in school? Explain.

Tell us about some of your extracurricular activities.

Describe an accomplishment of which you are particularly proud.

Is there anything else you would like the Admissions Committee to know about you?

Photo Release

Opt In:
I hereby grant Geibel Catholic Junior Senior High School and the Diocese of Greensburg, Pennsylvania, and its respective licensees, successors and assigns, the right and permission, with respect to those photographs taken of me or the minor(s) named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following:

1. To include such photographs on the Diocese of Greensburg website
2. To include such photographs on the Geibel Catholic Junior Senior High School Website, Facebook, Instagram, or X (Twitter) pages.
3. To use my name, or the name of the minor(s) on whose behalf I am signing, in connection with the foregoing.
o I hereby release, discharge and agree to indemnify and hold harmless the Diocese of Greensburg and its legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same.
o I hereby certify that I am the [parent and/or guardian] of the minor (minors) under the age of eighteen years named above, and hereby consent on behalf of said minor(s) to the use of any of the photographs taken of said minor(s) pursuant to the terms set forth in this Photographic Release, including, without limitation, the release, discharge and hold harmless provisions thereof.

Opt Out:
A parent may withhold permission to have a student photographed, videotaped, and/ or audiotaped during school- sponsored activities, learning experiences, and/or media events. As the parent or guardian of the student identified above, I understand that if I opt-out, my child will not be included in pictures taken by school staff, students, or anyone outside the school, including commercial photographers and the media, nor will my child’s picture be part of a school yearbook, memory book, memory video, sports team, club, or any other medium.
Note: This does not include videotaping by security cameras in school or on school buses. If you do not want your child to be photographed, videotaped and/or audiotaped, please sign below:

o DO NOT allow my child to be photographed, videotaped and/or audio taped during school- sponsored activities and/or learning experiences.

Photographic Release(Required)

Opt In

Opt Out

Name(s) of Student(s)(Required)

Signature of Student(s) Parent/Guardian(Required)

First Last

Parental Permission to Request and/or Release School Records

I hereby authorize Geibel Catholic Jr-Sr High School to request and/or release records relative to my children’s previous educational experiences. The specific records which I am requesting should be released and/or forwarded to the address below:

(School, Agency, Individual): Geibel Catholic Junior Senior High School
(Street Address): 611 E Crawford Ave
(City, State, Zip): Connellsville, PA, 15425
(Email): [email protected]
(Fax): 724-626-5700

Name of Student(Required)

First Last

Student Date of Birth(Required)

School Currently Attending(Required)

Parent/Guardian Signature(Required)

First Last

Date of Signing(Required)

Records Requested(Required)

(If Other is Selected) Please List(Required)

Sworn Statement Pertaining To The Prior Conduct Of A Pupil Seeking Admission

Section 1304-A. of the Public School Code of 1949, as amended, and referenced in Section 4245 of the Diocese of Greensburg School Policies requires that prior to the admission of any student, the parent, guardian, or other person having control or charge of the student shall provide the following sworn statement or affirmation.

Name of Student(Required)

First Last

Has the student ever been suspended or expelled from any public or private school in Pennsylvania or in any other state?(Required)

Yes

Did the suspension or expulsion involve weapons?(Required)

Yes

Did the suspension or expulsion involve alcohol?(Required)

Yes

Did the suspension or expulsion involve drugs?(Required)

Yes

Did the suspension involve infliction of physical or emotional injury to another person? – This includes hurting others through technology (cyberbullying, texting, etc.).(Required)

Yes

Has the student been arrested and/or have you been or are you on juvenile probation?(Required)

Yes

If the answer to any above question is “YES,” explain the incident and circumstances in detail including the school, date of suspension or expulsion, and a final decision regarding the incident.(Required)

I swear and affirm that the above information is true and correct. I understand that misrepresentation of the above data is a criminal act and punishable under the Pennsylvania Crimes Code.

Signature of Student(Required)

First Last

Date of Student Signature(Required)

Signature of Parent, Guardian, or other Person having Control or Charge of Student(Required)

First Last

Date of Parent/Guradian Signature(Required)

CAPTCHA

Online Application for Admission

APPLICANT INFORMATION

PARENT/GUARDIAN INFORMATION

Parent/Guardian (1)

Parent/Guardian (2)

CURRENT SCHOOL

TUITION INFORMATION

SACRAMENTAL INFORMATION

SIBLINGS

RELATIVES

Statement of Nondiscriminatory Acceptance Policy:

PARENT QUESTIONNAIRE – ALL APPLICANTS

STUDENT QUESTIONNAIRE – APPLICANTS ENTERING GRADES 7-12

Photo Release

Parental Permission to Request and/or Release School Records

Sworn Statement Pertaining To The Prior Conduct Of A Pupil Seeking Admission

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