New Student Application
Please fill out a separate application for each child you would like to attend HSCA. Submission of an application does not mean a student is enrolled. It is just the first step to enrollment. Students will be tested for academic placement and after the administration reviews the application and testing results, the school will notify you on whether or not your student is accepted for enrollment. All fees must be paid before a student is considered enrolled.
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Student’s full legal name: first, middle, and last *
Name student goes by: *
Student's birthdate: *
Student's gender: *
Student's age: *
Grade student is entering: *
Parent/Guardian Information:
Mother/Guardian's first and last name (legal documentation of guardians should be emailed to the school): *
Mother's cell number: *
Mother's email address (please list an email address that is frequently checked): *
Mother's marital status: *
Mother's occupation and place of employment: *
Please list any other phone numbers where the mother may be reached, such as a home or business number: *
Father's first and last name: *
Father's cell number: *
Father's email address (please list an email address that is frequently checked): *
Father's marital status: *
Father's occupation and place of employment: *
Please list any other phone numbers where the father may be reached, such as a home or business number: *
Who does the student reside with? (select all that apply) *
Please list the Mother's complete address (street address, city, state, and zip): *
Please list the Father's address if it is different from the Mother's (write SAME if it is not different from above): *
List  the names and ages of other children in the family, including those attending this school (write NONE if this doesn't apply): *
If you have other children of school age that you will not be enrolling at HSCA, please give a brief explanation:
Student Information:
Please list the most recent school the student has attended and include the school's name, address, phone number, and the grades attended there.  We need the full information in order to request the student's records. Providing this information also indicates you are giving permission to HSCA to access those records, if you choose to enroll your student. *
Please list any other schools attended in previous years and what grades they attended each school: *
Has this student been retained in a grade? *
If yes, which grade? Please explain why.
Has retention ever been recommended? *
If yes, which grade? Please explain why.
Please indicate the academic level of student’s previous work: *
Have you or any other previous educators expressed concern regarding the following? (check all that apply) *
Please explain any of the issues listed above that apply to the student:
Please select any consequences that have applied to the student: *
Please describe the nature of any previous disciplinary problems (write NONE if not applicable): *
Has this student ever had legal problems or used tobacco or illegal drugs? (If yes, please explain) *
Medical Information:
Does this student have any allergies? (If yes, please list) *
Has this student been diagnosed with any medical conditions or illnesses? (If yes, please list and explain) *
Has this student been diagnosed with any learning differences/disabilities? *
Does this student take medication for any condition listed above or for any other reason? (If yes, please explain) *
Does this student have any other physical, mental, or emotional problems we should be aware of? (If yes, please explain) *
Spiritual Information:
Do you consider your home a Christian home? *
What church do you attend? *
Are you a member? *
Do both parents attend church? *
Which most accurately describes your church attendance? *
Has the student ever made a profession of faith in Christ? *
Explain briefly why you desire a Christian education for your child: *
General Information:
What are your expectations of HSCA for your child? *
How did you hear about HSCA? *
What are your reasons for selecting HSCA? (select all that apply) *
Agreement of Parents:
I hereby certify that the information contained in this New Student Application Form is true and accurate to the best of my knowledge. I accept the conditions and requirements of all official policies and procedures of High Street Christian Academy, including the payment of all fees and charges of the school. I also agree that my students who enroll will comply with all school requirements and regulations.
Mother's signature: *
Father's signature: *
Guardian's signature (if applicable):
Date *
Non-discrimination policy:
High Street Christian Academy admits students of any race, color, national, or ethnic origin to all the rights, privileges, programs, and activities accorded or made available to students at the school. It does not discriminate on the basis of race, color, national, or ethnic origin in administration of its educational policies, admissions policies, tuition-aid programs, athletic, and other school-administered programs.
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