Date of Application _______ For School Year _____

 

____ Pre-School Application

____ K-8th Application (For Grade: __ )
____ Latchkey Needed (Days & Hours Needed: ________________________ )

1. Student Information:
__ Black ___ White ___ Hispanic ___ Asian/Pacific Islander ___ American Indian/Alaskan Native

Student's Name:__________________________________________________________

(Last) (First) (Middle)

Address: _______________________________________________________________

(Street) (City) (State) (Zip)

Telephone Number: ( ____ ) ______ - ________ Date of Birth:____ /____ /____

Local School District:_________________________ Which Building:____________

Living with (please circle): Father Mother Court Ordered Joint Custody

Previous schools student has attended: (Please give complete information)

(a)_______________________ Address:_________________________
Reason for Leaving: ___________________________________________

(b)._______________________ Address: ________________________
Reason for Leaving: ___________________________________________

2. Family Information

__ Married _____ Widowed ____ Divorced __ Separated __ Single

Church Attending: _________________________________________________

 

Church Address: __________________________________________________

Member ____ Regular Attendance ____ How long _______

Brothers or Sisters in Family

Name: _________________ Age: ____ Name: _________________ Age: ____

 

Name: _________________ Age: ____ Name: _________________ Age: ____

3. General Student Information

Has the student:

1. Had scholastic difficulties in school __ yes __ no

2. Been retained __ yes __ no (If so, what grade: __ )

3. Received tutoring, participated in Special Education classes, or undergone special academic and/or psychological testing __ yes __ no

4. Taken medication for academic purposes __ yes __ no

5. Been identified as gifted and/or talented __ yes __ no

6. Been diagnosed as having a physical handicap __ yes __ no

7. Been diagnosed as having emotional difficulties __ yes __ no

Remarks (Please explain any questions answered "yes") __________________________

_____________________________________________________________________

What terms would you use to describe this child's personality
_____________________________________________________________________

Student's special abilities, interests, and/or needs:
_____________________________________________________________________

Please comment on your reasons for desiring to enter your child in Springfield Christian Schools. Be as specific as you can, noting how you expect SCS to meet your child's needs, as well as how you expect your child to respond to life at our school. ________________________________________________________________
________________________________________________________________
________________________________________________________________

Would you like to share with us the individual or family who referred you to Springfield Christian Schools __________________________________

Please provide answers to the following questions. If the child is enrolling in K-3^rd grade, parents answer. If the child is enrolling in 4^th-8^th grade, have the child answer for him/herself.

 

1) According to your understanding, who is Jesus Christ

2) How would you describe your relationship to Him

Springfield Christian Schools admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and other school-administered programs because we acknowledge that there can be no preferential treatment with God. (Romans 2:11)