Application for Student Admission
School Year (*)

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Present Grade (*)

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Name (*)

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City

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Zip

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Social Security number

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Age

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Birth Date (*)

Student Birthdate
Person to contact in emergency)

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Emergency Contact Phone Number

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Last Grade Completed (*)

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Grade Applying for (*)

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Address


State

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Telephone (*)

Please type your full name.
Place of Birth

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Sex (*)

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Name of Last School Attended

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Address of Last School Attended

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Student Information
Father's Name (*)

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City

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Zip

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Social Security Number

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Position

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Mother's Name (*)

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City

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Zip

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Social Security Number

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Position

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Parent's Marital Status (*)

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Other children in this family

Names

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Age

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Address


State

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Telephone (*)

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Fathers Employment

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Business Phone (*)

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Address


State

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Telephone (*)

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Mother's Employment

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Business Phone (*)

Please type your full name.
Does child live with both parents (*)

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If not indicate with whom

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School

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Family Information
Grandparents Name (*)

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City

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Zip

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Grandparents Name (*)

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City

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Zip

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Address


State

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Grandparent's Information



Address


State

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Church Attending

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City

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Zip

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Father Christian? (*)

Please tell us how big is your company.
If yes, briefly state your salvation experience

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Has the Applicant ever made a profession fo faith in Christ? (*)

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Address

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State

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Mother Christian? (*)

Please tell us how big is your company.
If yes, briefly state your salvation experience

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Church Affiliation
Family Physician (*)

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Address


State

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Family Dentist (*)

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Address


State

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Does student have any physical challenges or allergies? (*)

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Does student have State required immunizations and can you provide the school with records to verify this? (Only Kindergarten or out of state applications) (*)

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Telephone (*)

Please type your full name.
City

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Zip

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Telephone (*)

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City

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Zip

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If yes, briefly state the condition

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Medical Information
Has student ever been expelled, dismissed, suspended, or refused admission to another school? (*)

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Has student ever been in trouble with the law, arrested, etc? (*)

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Has student ever been moved ahead or held back a grade in school? (*)

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If yes to any of the above, please explain:

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Has student ever had any disciplinary difficulties? (*)

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Has student ever used tobacco ro drugs of any kind? (*)

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Please indicate academic level of student's previous work: (*)

Please specify your position in the company

Scholastic Information

  

Position (*)

Please specify your position in the company

This form is an example. Please check our knowledgebase for articles related to how you should build your form. Articles are updated daily. http://www.rsjoomla.com/

This form is an example. Please check our knowledgebase for articles related to how you should build your form. Articles are updated daily. http://www.rsjoomla.com/

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