Admission Form

/Admission Form
Admission Form 2017-02-09T16:17:48+00:00
Download Hardcopy Application Here.

Complete the online application below OR download a PDF hardcopy here. 

 

Returning Student YesNo

Last Year Attended NCA
Date of Application
School Year
Applying for Grade
Email

Student's Name (Last, First, Middle)



Male/Female MaleFemale

Address

(Street)
(City)
(Zip Code)

Place of Birth
Date of Birth
Age
Social Security No.



Copy of Social Security Card or Birth Certificate (a must for Kindergarten)

Ethnic Origin
County of Residence
School District in which you reside


Father's Information

Father's Name (Mr./Dr./Rev.)
Address (Street,City, State, Zip Code)

Father’s Phone Numbers
Home
Work
Cell

Education
High School Graduate? YesNo

Years of College Completed
Degree Achieved
Father’s Occupation/Position

Employer Information
Employer
Employer’s Address (Street, City, State, Zip Code)

Mother's Information

Mother's Name (Ms./Mrs./Dr./Rev.)
Address (Street,City, State, Zip Code)

Mother’s Phone Numbers
Home
Work
Cell

Education
High School Graduate? YesNo

Years of College Completed
Degree Achieved
Mother’s Occupation/Position

Employer Information
Employer
Employer’s Address (Street, City, State, Zip Code)

If there are other children in your family, please complete:
Child 1
Name
Age
School
Child 2
Name
Age
School
Child 3
Name
Age
School

What is the marital relationship in your home?

Is the student living with at least one parent? YesNo

If “no”, with whom is student living (grandparent, guardian, etc.)

If parents are divorced or separated, who has legal custody of the student? (Name of legal guardian if other than a parent)
(Current legal documents must be kept on file in the student’s records.)

Name and address of living grandparents.
Paternal
Name:
Telephone:
Address:

Maternal
Name:
Telephone:
Address:

Person responsible for bills, if other than parents.
Name:
Telephone:
Address:

Please list schools previously attended, most recent first (School, Address/Zip, Dates Attended, Grades Completed):

Why is your student transferring from his/her present school?

Student’s grades have been:

Has the student ever been:

If so, please give full details on a separate sheet of paper, including the principal’s name and address of the school.

Has your child, to your knowledge, used any type of drugs, alcohol, tobacco, or has he/she ever been in any type of trouble with authorities? YesNo

If so, please give full details, including the principal’s name and address of the school.

Has the student ever repeated a grade? YesNo

Grade(s)

Has the student ever been treated for any type of learning disability, ADHD or emotional difficulties? YesNo

If yes, please identify and explain.

Has student been diagnosed as having any of the following problems?

Has student been in any special education program? YesNo
Grade(s)
If yes, please describe the program:

Describe the student’s interests, talents, abilities:

List the subjects in which you believe your child excels.

List the subjects which you believe are difficult for your child.

Are there any medical reason the applicant cannot participate in the physical education program?
YesNo

If “yes”, please explain.

A physical form and immunizations record is required of all new students.

Physician’s Name
Telephone
Physician’s Address (Street, City, State, Zip Code)

Dentist’s Name
Telephone
Dentist’s Address (Street, City, State, Zip Code)

Emergency Name
Telephone
Contact’s Address (Street, City, State, Zip Code)

If you have further information which may assist in the guidance of your child at NCA such as pertinent medical or other data the school should be aware of, please indicate below.

Please state your personal Christian Experience and Faith:
Father:

Mother:

Why do you want your child to enter Nazarene Christian Academy?

How were you made aware of NCA?

Are you personally in agreement with or understand that the following statement of faith serves as the basis and foundation of NCA?
We believe the Bible to be the inspired and only infallible authoritative Word of God.
We believe that there is one God eternally existent in three persons: Father, Son & Holy Spirit
We believe in the deity of our Lord Jesus Christ, in his virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory.
We believe that man is sinful by nature and that regeneration by the Holy Spirit is essential for his salvation.
We believe in the continuing ministry of the Holy Spirit, by whose indwelling the Christian is enabled to live a Godly life.
We believe in the resurrection of both the saved and lost; they who are saved unto life, and they who are lost unto damnation.
We believe in the creation of man by the direct act of God.
We believe in the spiritual unity of believers in our Lord Jesus Christ.

Father
Mother
Guardian

Of which church or parish is your family a member?
Address (Street, City, State, Zip Code):

Please list the name of your clergyman.

What is the frequency of your family’s church attendance?

The following is required before admission into Nazarene Christian Academy is considered:
Application and application fee (non-refundable).
Statement of Agreements signed. (Financial Agreement, Statement of Cooperation.)
Student records release form signed.
An entrance interview and an entrance test are required.
A copy of most recent report card, standardized test results.
To the best of my ability, I/we have provided accurate, truthful information on this application form. I understand that this application cannot be considered without the application/enrollment fee and that if my student is accepted; the application/enrollment fee is not refunded except as outlined in the Financial Policy Agreement.

BOTH PARENTS SIGNATURE REQUIRED, UNLESS A SINGLE PARENT HOME:
Father/Guardian

Date

Mother/Guardian

Date