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Student First Name*
Student Last Name*
Parent/Guardian First Name*
Parent/Guardian Last Name*
Current Grade* —Please choose an option—4th5th6th
Current School*
Best Phone Number
Email of Parent/Guardian*
Best time for phone contact* —Please choose an option—AnytimeMorningNoontimeAfternoonEvening
What school year are you looking for placement?* —Please choose an option—Current School YearUpcoming School Year
Where did you hear about us?
If someone referred you, please list their name below.
Nativity Preparatory Academy15 Whalin StreetRochester, NY 14620585-271-1630