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Application Form 2017-2018

Please complete the following information.

Return this form to Covenant Christian School at the address above.

 

Legal Name of student applicant:

_______________________  ________________________  ____________________

Last                     Middle                First

 

(__)Male (__) Female

 

DOB________________  Race__________________  Grade to enter________

MM-DD-YYYY

Prior school____________________________________________________________

 

Student Address:  ______________________________________________________________________

No. and street

_________________________________   _______________   ___________________

City                            State            Zip

 

Mother’s Primary Phone______________________________

Father’s Primary Phone______________________________

 

Mother’s address the same? (__)Yes  (__)No

Father’s address the same?  (__)Yes  (__)No

 

Mother’s email____________________________________________

Father’s Email____________________________________________

 

Faith:

Church affiliation

What church do you currently attend?  How often do you attend?  Are you a member of the church?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Personal Testimony

When did you become a Christian?  How did you come to know Christ?

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Prayer

Describe your routine or habit of prayer.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Covenant Philosophy

Why do you desire to enroll your child(ren) in Covenant Christian School?  What do you think it means to become part of a covenant community of learners?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Statement of Faith

Have you read our Statement of Faith?  (__)Yes

Are you in agreement with our Statement of Faith in its entirety?  (__)Yes (__) No

If you do not agree with our Statement of Faith in its entirety, please explain:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Academics:

 

Background:

Has your child ever been retained a grade? Advanced a grade? Tested as gifted?

Please explain.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Disciplinary Action:

Has your child ever been suspended or expelled from school?  Please explain.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Overview:

What would you consider to be your child’s academic strengths and/or weaknesses?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

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Does your child have an IEP?  (__) Yes  (__) No

Learning Challenges:

Does your child have any learning challenges that we should be aware of?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Accounts Receivable/ Primary Contact:

_________________________    ____________________    _______________________

First name                                              Middle name                        Last name

 

DOB ______________________        Gender  (__) Male  (__) Female

MM_DD_YYYY

Goes by_____________________________

Marital Status_________________________

Spouse’s Name ________________________________________________________

 

Email_________________________________________________________________

Primary phone number    (_____) ____________________________

Alternate phone number  (_____) ____________________________

 

Employer ______________________________________________________________________

Occupation_____________________________________________________________

Work phone (____) __________

 

Related to the student?  (__)Yes   (__)No

Relationship to the student ______________________________________________________________________

Lives with student?     (__)Yes   (__)No

Address (if different from student):

(Street)________________________________________________________________

(City)_________________________ (State)________  (Zip)______________________

 

Primary contact for student?  (__)Yes  (__)No

First emergency contact for the student?  (__)Yes  (__)No

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Secondary Contact

 

________________________   ________________________   ___________________

First name                                       Middle name                                              Last name

 

DOB________________________    Gender  (__) Male   (__) Female

MM-DD-YYYY

 

Goes by____________________________

Marital Status_______________________

Spouse’s Name_________________________________________________________

 

Email________________________________________________________________

Primary phone number    (_____) ________________________________

Alternate phone number  (_____) ________________________________

 

Employer______________________________________________________________

Occupation_____________________________________________________________

Work Phone (____) ______________________

 

Related to the student  (__) Yes  (__) No

Relationship to the student________________________________________________

Lives with student?   (__)Yes  (__)No

Address (If different from student):

(Street)________________________________________________________________

(City)_________________________ (State) ________________ (Zip)______________

 

First emergency contact for student  (__)Yes  (__)No

 

For Office Use Only

Date Received Interview scheduled SMT Decision Notification Sent

 

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