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Date
School Year
Applying for Grade:
Student Information
First Name
Last Name
Name Student Goes By
Sex
Male
Female
Address 1
Address 2
Country
City
State
Zipcode
Age
Date of Birth
Birthplace (City, State)
School Last Attended
Previous School's Phone Number
Previous School's Address
Has the student ever been retained?
Yes
No
If yes, what grade?
Has the student ever been expelled?
Yes
No
If yes, state the reason.
Has the student ever been suspended?
Yes
No
If yes, please state the reason.
Has the student ever been in any difficulty with the civil authorities?
Yes
No
If yes, please give the details and reason for the difficulties.
Are there any factors in the student's life that may affect his/her progress or activity in school? (i.e. absence of a parent, physical limitations, disabilities, etc.)
Has the student experienced any learning difficulties or been diagnosed with ADD or ADHD?
Yes
No
If yes, please explain further
Are you enrolling or re-enrolling other students?
Yes
No
Church Affiliation
Attending Church
Pastor's Name
Church Address
Church Number
Is the student a member?
Yes
No
Does the student attend on a weekly basis?
Yes
No
Family Information
Father or Guardian
First Name
Last Name
Birthplace
Personal Email Address
Phone Number
Employer
Occupation
Address of Employment
Work Phone Number
Work Email Address
Mother or Guardian
First Name
Last Name
Birthplace
Personal Email Address
Phone Number
Employer
Occupation
Address of Employment
Work Phone Number
Work Email Address
Parents' Marital Status
Married
Widowed
Divorced
Single
Child resides with:
Both parents
Father
Mother
Guardian
Are there any custodial difficulties?
Number of children living at home:
Number of others living at home:
Will you be able to settle accounts promptly?
Yes
No
Explain why you wish for your child to attend Union Grove Christian School.
Submit
