Placement Exam Registration

Student Name*

First Last

Email to be used for testing information*

Contact Phone Number for testing information*

Gender*

Male
Female

Birthdate*

Alternate Phone number:

Parent or Grandparent Legacy

Is the student's parent or grandparent a graduate of PCHS?

Mother

Mother First/Last Name Maiden Name Graduation Year

Father

Father First/Last Name Graduation Year

Grandmother

Grandmother First/Last Name Maiden Name Graduation Year

Grandfather

Grandfather First/Last Name Graduation Year

School Information

From what school will the student graduate this spring?

School Name*

School City*

Student's Religion*

Parish/Church Name

Parish/Church City

Extended Time With IEP or 504 plan*

Yes, my child requires extended time accommodations and I will provide the necessary documentation, an IEP or 504 plan, on or before December 2nd, 2024.
No, my my child does not requires extended time.

Providence Catholic High School offers extended time (1.5x) on the High School Placement Test (HSPT) to students who qualify through a formal IEP or 504 Accommodation Plan. Documentation of a formal IEP or 504 Accommodation Plan must be submitted to Providence Catholic High School by December 2nd, 2024. Electronic documentation should be submitted to Mrs. Toutant (atoutant@providencecatholic.org). Hard copies of documentation should be provided to Mrs. Sinko in the main office. After you submit the required documentation, Mrs. Toutant will send an email confirmation to you if extended time has been approved. If you have questions about accommodations on the HSPT or want to request the consideration of additional accommodations, please contact Mrs. Toutant (atoutant@providencecatholic.org).

Student's Parent/Guardian Information

Father*

Living
Deceased

Mother*

Living
Deceased

With whom does the student reside?*

Address*

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

Parent Authorization Form Class of 2029 Applicants

I grant permission for Providence Catholic High School to dialogue openly with appropriate parties at my student's current school regarding current levels of performance as it relates to my student's admission and placement for the 2024-2025 school year. In addition, I will allow authorized representatives from Providence Catholic to share entrance exam results with my student's current school for the sole purpose of curriculum planning and placement. I understand that any information exchanged will be kept confidential according to the stipulations of the Family Education Rights and Privacy Act of 1974.

Electronic Signature*

Yes, I agree that Providence Catholic can dialogue and share test scores with my student's school for curriculum planning. and placement purposes

Signature of Parent or Guardian (Please type in full name):*

List the name(s) of the parent(s)/guardian(s) with whom the student resides

Parent/Guardian*

First Last

Maiden Name

Last

Email*

Phone*

Parent/Guardian

First Last

Maiden Name

Last

Email

Phone

Registration Fee:*

Price: $25.00 Quantity:

Total

$0.00

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