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New Student Application 23/24
*This form is not designed for Mobile devices
Application Fee - A non - refundable $100 per student is collected after the application is submitted via separate invoice

Student Information

First Name

Last Name

Grade Level Applying For

Today's Date

Address

Phone

Email

Birthday

Male

Female

Grade Currently Enrolled In

School Currently Attending

Current School Phone Number

Are you able to provide transcripts or testing information from this school?

Yes

No

NA

Has your child been enrolled in, or recommended for any of the following special classes? Please note, indication of special services will not exempt your child from attending CCCA. We need a thorough and honest response in order to best serve your child. Please check all that apply

Physically Handcapped

IEP/MET/504

Speech Therapy

Learnig Disability

GATE

Other

If yes, Please explain

Has your child ever been referred to a school Administration for discipline, suspension, or expulsion? If yes, please explain

List the names and grades of any siblings currently enrolled at CCCA

List the names and grades of any siblings applying for enrollment at CCCA

Parent Information

Father Name

Occupation

Employer

Phone Number

Lives With Student

Mother Name

Occupation

Employer

Phone Number

Lives With Student

Step Parent Name

Occupation

Employer

Phone Number

Lives With Student

Maital Status of Parent/s

Single

Married

Divorced

Separated

Widowed

Annual Tuition is $6500/year/student are you financially able to pay the annual tuition? If no, plase list the amount you are able to pay

Are you anticipating receiving any type of Grant or Scholarship to attend? If yes, please list below

What do you see as your role or part of your child's education?

How did you learn about our school?

Why would you like your child to attend Calvary Chapel Christian Academy?

Church Information

Do you attend a church on a regular basis? If yes, what church and for how long?

Both parents' signatures are requested whenever possible.

I/We certify that the information found on this application is complete and accurate. I understand that any information found to be inaccurate may be considered grounds for dismissal from this school.

Mother Signature

Printed Name

Today's Date

Father Signature

Printed Name

Today's Date

Thank you, Someone will be in contact with you

928-536-4479

Member of Calvary Chapel Education Association (CCEA)

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New Student Application 23/24 *This form is not designed for Mobile devices Application Fee - A non - refundable $100 per student is collected after the application is submitted via separate invoice

Student Information

Are you able to provide transcripts or testing information from this school?

Has your child been enrolled in, or recommended for any of the following special classes? Please note, indication of special services will not exempt your child from attending CCCA. We need a thorough and honest response in order to best serve your child. Please check all that apply

Parent Information

Church Information

New Student Application 23/24
*This form is not designed for Mobile devices
Application Fee - A non - refundable $100 per student is collected after the application is submitted via separate invoice