St. Augustin Catholic School Forms

Click on the category below for school forms  Please complete, and return forms to the school office unless otherwise noted.  If you cannot find the form you are looking for, or have difficulty downloading any of the following forms, please contact the school office 515-279-5947.

Enrollment Forms


Enrollment Application

Saint Augustin Parish ACH Tithing Form

FACTS Tuition & Fee Payment System

FACTS account set-up for new families

Extended Care Program Registration Form

Extended Care ACH Authorization Form

Extended Care Rates

Home Language Survey

Free and Reduced Lunch Forms

Free and Reduced meal benefits are available at St. Augustin School. If your child(ren) currently receive benefits, you must reapply each year or your eligibility will expire. If you are not currently receiving meal benefits but would like to know if you qualify, please see the income eligibility guidelines below.

Please return completed applications to St. Augustin School, Attn: Rachelle Watters. If you have questions or need assistance with your application, please call or email Mrs. Rachelle Watters in the school office.

Free and Reduced Lunch Applications can be submitted at any time during the school year.

Informational Letter to Parents/Guardians 

Application for Free and Reduced Price School Meals/Milk

Instructions for Form Completion

Income Eligibility

Waiver Statement

Medical Forms
Athletics Pre-participation Physical Form |All students participating in St. Augustin Catholic School athletics must have a current physical on file with the school nurse. 

Certificate of Dental Screening | All incoming Kindergarten and new 1st - 8th-grade students need a Certified Dental Screening on file with the school nurse. 

Certificate of Dental Screening Exemption

Des Moines Area Catholic Athletic League Handbook | The handbook includes forms and waivers for players and coaches

Diet Modification Request Form

Food Allergy Action Plan

Immunization Record | All incoming Preschool, Optional-K, Kindergarten, students entering 7th grade, and new 1st - 8th-grade students need an up-to-date immunization record on file with the school nurse.

Immunization Record Exemption

Permission for Administration of Medication |Return this completed form to the school nurse with any medication to be given to your child at school.  This includes over the counter and prescription medications.

Permission for Self Administration of Asthma/Anaphylaxis Meds |Return this completed form to the school nurse if your child requires an asthma inhaler or anaphylaxis medication they need to carry with them in the classroom.  

Student Physical Form | All new students as well as all incoming Kindergarten, 4th and 7th-grade students need to have an updated physical by the beginning of the school year.  Please print this form to take to your doctor appointment.  An equivalent form printed at the doctor's office may also be submitted.  

Vision Card or Vision Screening| One of these forms are to be filled out for all incoming Kindergarten and 3rd-grade students. The Vision Card is to be completed by an Optometrist or Ophthalmologist.  The Vision Screening form may be completed by the student's Pediatrician or Licensed Personal Care Provider.  

Middle School Service Hours

Middle school students at St. Augustin Catholic School are required to complete service hours each school year.  The number of hours will vary by grade. 

Works of Mercy 

  • 6th grade: 5 hours/year
  • 7th grade: 10 hours/year
  • 8th grade: 15 hours/year 
School Supply Lists

Pre-Kindergarten Supply List

Transitional Kindergarten Supply List

Kindergarten - 8th Grade Supply List 

Transportation Reimbursement

List of Public School Districts

The following public school districts are no longer accepting paper applications for non-public transportation reimbursement requests.  You will need to go directly to their website to submit your transportation reimbursement request.

Des Moines Public School District Transportation Reimbursement Online Submission I

Ankeny Public School District Transportation Reimbursement Online Submission l

Southeast Polk Public School District Transportation Reimbursement Online

You must submit each semester by December 1st and May 1st each year in order to be reimbursed for the entire year.

Outlying School Districts Transportation Reimbursement Form | Please submit this form if you live in a non- Des Moines Public School district no later than December 1st and May 1st each year.  You must submit each semester in order to be reimbursed for the entire year.  

Volunteer Forms

Volunteer Cafeteria Parent Duties | Reporting Agreement    Please sign and return the reporting agreement to Mrs. Moore in the Cafeteria. 

All cafeteria volunteers must complete reading through this Iowa Civil Rights Training for Lunchroom Programs.

Volunteer Driver Form | Parents are often asked to volunteer as drivers for class field trips. This is a great way for parents to see their children and get to know the other students in the class. When needed, teachers will request volunteers.  

What Form When?

PreKindergarten and Transitional Kindergarten:

Immunization Record and Student Physical Form


Certified Dental ScreeningImmunization RecordVision Card or Vision Screening, and Student Physical Forms

3rd Grade:

Vision Card or Vision Screening Form | Vision Card to be completed by Optometrist or Ophthalmologist.  Vision Screening Form may be completed by the student's PCP or Pediatrician. 

4th Grade:

Student Physical Form

7th Grade:

Immunization Record and Student Physical Forms