8. Please list the school last attended or presently attending (if home schooled, please indicate under "Name of School").

    Name of School______________________________________________________________________________________________________

    Phone_____________________________ City/State/Zip____________________________________________________________________

b. Name of Student__________________________________________ Grade Completed_________________________________________

    Name of School______________________________________________________________________________________________________

    Phone_____________________________ City/State/Zip____________________________________________________________________

c. Name of Student__________________________________________ Grade Completed_________________________________________

    Name of School______________________________________________________________________________________________________

    Phone_____________________________ City/State/Zip____________________________________________________________________

9. Calvary Christian Academy is not staffed to handle students with severe learning disabilities or those who

   have trouble behaviorally. For your child's best interest, please be candid when you answer the following

   questions. (If more than one child is applying, please consider each one when answering.) Further elaboration

   on your answers may take place during an interview.

a. Has the student ever been referred for testing or placed in a special program? Yes____ No____________________________

    If so, please explain_________________________________________________________________________________________________

b. Has the student received any other special help or tutoring? Yes____ No______________________________________________

    If so, please explain_________________________________________________________________________________________________

c. Has the student ever repeated a grade for any reason?____ If so, which grade?________________________________________

    If so, please explain_________________________________________________________________________________________________

d. Has the student ever been suspended or expelled by a previous school? Yes____ No__________________________________

    If so, please explain_________________________________________________________________________________________________

e. Has the student ever seen a counselor/doctor/psychiatrist for any type of social, behavorial, or mental

    problems? Yes____ No____ If so, briefly state the nature of the problem:______________________________________________

________________________________________________________________________________________________________________________

f. Has the student ever been examined or treated by a counselor/doctor/psychiatrist for hyperactivity or

    attention deficit disorder (ADD or ADHD)? Yes____ No_________________________________________________________________

g. Do you suspect or have you been told that your child might have dyslexia? Yes____ No_________________________________

h. Has the student ever been involved in legal problems or been arrested? Yes____ No___________________________________

10. Do you support the following aspects of the curriculum and school policies?

Please circle:   Y=Yes    N=No     Q=Qualified Answer

Required outside reading Y-N-Q     Frequent memorization (elementary) Y-N-Q

Latin Y-N-Q                                      Learning Disability Policy Y-N-Q

Uniform Y-N-Q                                 Applied classical ed. philosophy Y-N-Q

Qualifications, if any____________________________________________________________________________________________________

11. If a conflict arises between you (or your child) and the classroom teacher, an administrator, or the school board,

would you be willing to follow the appropriate chain of command to resolve the problem, as described in the school

handbook (in accordance with Matthew 18?) Yes____ No_________________________________________________________________

12. All tuition payments are due on the first day of each month. Upon acceptance, the first month's tuition and book fee

for each enrolled child. These fees are non-refundable and must be paid before students are admitted.

TO MAKE THIS APPLICATION COMPLETE, PLEASE INCLUDE THE FOLLOWING:

1. a $25.00 non-refundable registration fee per family;

2. A copy of the most recent achievement / test scores, if available;

3. Report cards from the most recent quarter and the previous year, if available;

4. Vaccination record

5. Copy of birth certificate

6. CCA Student Interview Form (7^THgrade and up)

After the school receives the completed appplication and other required materials, we will contact you to arrange an

interview at the school. Placement testing will occur in August, and the school will notify you of the dates.

All information will be kept confidential.

Parental Signature

I certify that this application is correct and complete.

Date___________________________

Parent or Guardian______________________________________