ADMISSIONS APPLICATION 2021-2022 Student InformationStudent Name* First Middle Last Preferred Name (If different than above): First Gender* Male Female Grade applying for* Current/Previous School* Date of birth* Month Day Year Child's age* Address of child* City* Zip code* Phone number* Please select student's ethnic background* African-American Asian Caucasian Latino Native American Other Family InformationFather Name Marital Status Select one Natural Parent Step-parent Mother Name Marital Status Select one Natural Parent Step-parent Who has legal custody of this student? Please select all that apply.* Both parents Father Mother Guardian 1 Guardian 2 With whom does this student live? Please select all that apply.* Both parents Father Mother Guardian 1 Guardian 2 Guardian 1 - Name: Guardian 1 - Marital Status: If related to student, please specify: Guardian 2 - Name: Guardian 2 - Marital Status: If related to student, please specify: Parent/Guardian 1 - Email: Cell # Employer/Occupation: Work # Parent/Guardian 2 - Email: Cell # Employer / Occupation: Work # Please list the names of each person authorized to view the academic record of this student:* Are all fees/charges paid to date to current/previous school?* YES NO If no, please provide a brief explanation: Please provide requested information about the siblings of this student:NameAgeName of current school Educational HistoryList your child's skills, interests and abilities: Has your child ever been dismissed, suspended, or disciplined at any school?* YES NO If yes, please provide name of school and a brief explanation: Does your child have any medical or health conditions that affects learning needs?* YES NO If yes, please provide name of school and a brief explanation: Has your child ever been tested, diagnosed, or enrolled in any ESE (Special Education Program) or had a Medical 504 plan or an IEP (Individual Education Program)?* YES NO If yes, please specify and discuss the results in the space below (it would be very helpful to also have a copy of the report). Christian EducationBriefly describe your understanding of Christian education:* How important is it to have your child in a Christian school and why?* Educational GoalsWhat do you believe your role as a parent is in your child's educational success?* What role(s) do you envision Indigo Christian Junior Academy having in relation to these goals both in the coming school year and long term?* What is your child's emotion about the possibility of attending Indigo Christian Junior Academy? Please select all that apply:* Ecstatic Happy No emotion Not over the top excited Unhappy Anxious Sad Other Religious BackgroundFather/Guardian 1: What is your church background?* Do you currently attend church?* If yes, where? Briefly describe what having a personal relationship with God means to you:*Mother/Guardian 2: What is your church background?* Do you currently attend church?* If yes, where? Briefly describe what having a personal relationship with God means to you:* Student: Is child a baptized member of a church family?* YES NO If yes, where? How did you hear about Indigo Christian Junior Academy?Untitled Indigo Christian Junior Academy Website Advertisement - Flyer, Radio, Newspaper Family member If it was a referral from a current Indigo Christian Junior Academy family, please provide name so that we may properly thank them: Other: CAPTCHA
