Application for Student Enrollment, Central Iowa Christian School
Welcome! Deciding how to educate your child is an important decision for your child's future and for your family.

Complete the following application for consideration to be enrolled at Central Iowa Christian School.
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Name of child *
Gender *
Grade entering *
Age *
Will your child be full time or part time? *
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth
List any disabilities and/or special needs your child has *
Past Record of Child's Education *
School, City/State, Years attended
Has your child ever been dismissed from school for behavior problems? *
Has your child ever been dismissed from school for poor work/effort? *
How would you rate your child's scholastic ability? *
Is your child accustomed to bible reading and prayer in the home? *
Father's Information
Father's Name *
Father's Occupation *
Father's Address
Father's Telephone Number
(xxx) xxx-xxxx
Father's Email Address
Mother's Information
Mother's Name *
Mother's Occupation *
Mother's Address
if different father's address listed above
Mother's Telephone Number
Mother's Email Address
Marital Status of Parents
Clear selection
Siblings
Please list siblings from oldest to youngest. *
Name, Age, Grade, Where enrolled for school
Are all of your school-age children being registered at CICS? *
If not all of your school-age children are being registered at CICS, please explain why. *
Church Information
You do not have to be a Christian to attend CICS, though we have a statement of faith or openness to faith-teachings to which all families must agree.
Church Affiliation *
Are you a member of this church?
Clear selection
Do you attend regularly?
Clear selection
Are you active in this church?
Clear selection
Why do you wish to enroll your child at CICS? *
How did you hear about CICS? *
Required
Were you referred by a CICS family? If so, who? *
Do you anticipate the need for tuition assistance? *
Tuition assistance will be granted if funds are available and only up to 40% of the cost of tuition.
To keep tuition costs down and build community, parents are expected to be active in the school, including volunteering for various events and fundraisers. We ask for no less than 10 volunteer hours per family per child. Are you prepared to meet these expectations? *
Is there any additional information you feel we should know in considering this application?
Thank you for your submission!
Your application cannot be considered until we receive your $25 application fee. Please mail or drop off a check to continue the application process. The application fee is non-refundable.

During the application process, you may be contacted by a CICS board member to set up an interview.

Upon acceptance, you will be notified by a school board member.

Central Iowa Christian School
201 380th Avenue
Grinnell, IA 50112
641-236-3000
cics@centraliowachristianschool.org
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