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Request Information
Mrs. Lisa Popham, Assistant Principal for Curriculum & Instruction, can be reached by phone at (812) 476-4973 ext. 205, email at lisapopham@reitzmemorial.org, or by filling out the following form.
Student Information:
First Name:
Last Name:
Gender:
Date of Birth:
Current Grade Level:
Current School:
Year seeking entrance:
Grade applying for:

Parent/Guardian 1 Information:
First Name:
Last Name:
Relationship to student:
Are you an alumnus of Reitz Memorial HS? Yes       No
     If yes, what year did you graduate?
E-Mail Address:

Parent/Guardian 2 Information:
First Name:
Last Name:
Relationship to student:
Are you an alumnus of Reitz Memorial HS? Yes       No
     If yes, what year did you graduate?
E-Mail Address:

General Information:
Mailing Address:
City:
State:
Zip Code:
Primary Phone:  
Secondary Phone:  
Student primarily resides with:
If Catholic, family's parish:
Questions/Comments:


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