Prospective Students - Information Request

Required Fields *
Student's First Name*:
Student's Last Name*:
Mother's First Name*:
Father's First Name*:
Parent's Last Name*:
Address*:
Address 2:
City*:
State*:
ZIP Code*:
Home Phone Number*:
Work Phone Number*:
E-mail:
Student's Birthday:
Student's Current School:
Student's Current Grade:
Student would enter Covington Catholic in (month/year):
How did you hear about Covington Catholic (Please check all that apply):	Radio Print Ad News Story Covington Catholic Publication Direct Mail Other
Do you have a family member connected to Covington Catholic High School:	YesNo
Questions, comments, or if you have any other interests not listed please indicate here:

***when pushing submit this website will use your home email address to send in the form.