GATEWAY CHRISTIAN ACADEMY P.O. BOX 246 BETHEL SPRINGS, TN 38315
PLEASE FILL OUT EACH ANSWER. WE NEED ALL THE INFORMATION WE ASK FOR. THANK YOU!
STUDENT INFORMATION:
School Term/Year_______________Date______________ Cell Ph# ______________________
Full Name____________________________________________________________________
Address__________________________________________Home Ph#( )__________________
City________________________________________State_____________Zip______________
County_____________ Age_______ Birthdate________________ Sex ________ Race _________
S.S. # _____________________ (Student)Driver's Lic. # ___________________________
School Last Attended______________________________________ County ______________
Ph# __________________________ Fax# _________________________
School's Complete Address ___________________________________________________________
_________________________________________________________________________________
Last Grade Completed_______ Current Grade Level _______ Withdrawl Form Included: ________
Board of Education Ph# ____________________________Fax# __________________________
PARENT/LEGAL GUARDIAN INFORMATION:
Father's Full Name_________________________________ Cell Ph# ____________________
Employment________________________________ Diploma/G.E.D ____________________
S.S. #_____________________________Business Phone___________________________
Mother's Full Name_____________________________________ Cell Ph#_____________________
Employment_________________________________ Diploma/G.E.D. _______________________
S.S. #_______________________Business Phone___________________________
Contact Ph# _________________________ 2nd Ph# _________________________________
SCHOLASTIC INFORMATION:
Has Student ever been expelled, suspended, or refused admission to another school?_____
If yes, explain in detail:___________________________________________________________
____________________________________________________________________________
Has student ever had disciplinary reports at school?_________
If yes, explain:___________________________________________________________
Does student have a juvenile or arrest record?____________
If yes, explain___________________________________________________________
Has student ever used/brought to school any tobacco or nonprescription drugs of any kind?____
If yes, explain:___________________________________________________________
Please indicate academic level of student's previous work:
Excellent_________Good___________Average_________Poor___________
Has student ever failed an academic subject in school?__________
If yes, explain:___________________________________________________________
Is student currently in any advanced or lower level classes? _____ If yes, explain___________
______________________________________________________________________________
Report Card or Transcript Included: _________ If No, Explain? _____________________________
GENERAL INFORMATION:
How did you hear about this school?__________________________________________
Reason for selecting this school?_____________________________________________
FEE'S:
Registration Fee: $50.00 amount paid today _________________
1st Tuition Fee: $85.00 amount paid today __________________
Answer Key Fee: $60.00 amount paid today ________________ Total Fee's paid today:_____________
Fee's must accompany application forms and are non-refundable. Money Orders only please.
Application must be filled out completely and signed. Remember to include a recent photo of the student and include a report card or transcript. All info is needed before application can be processed.
If child is in High School you must include a High School Transcript or Withdrawal Form with Application.
PLEASE FILL IN CONTRACT AGREEMENT OF YOUR CHOICE:
I _______________________________ do hereby agree to Homeschool with Gateway Christian Academy for 10 months at the monthly tuition rate of $85.00 I also agree to monitor my child's academics for the state minimum of 4 hrs each day 5 days a week. I promise to see that my child completes Academic work that is required and takes tests for each subject in a timely manner by Gateway Christian Academy's rules. I agree and promise that I will ask permission from Gateway Christian Academy before I withdraw my child from the Homeschool program and pay all accounts owed, plus an early termination fee. All fee's are non-refundable once received at student's Registration. I also agree to purchase resource books or materials as needed for my child through out the school year.
I _______________________________ do hereby agree to Homeschool my child with Gateway Christian Academy for the school year _____________ and I promise to monitor my child's academics and testing schedule according to the state minimum of four hours daily for five days a week. I am paying for my child's Booklets-Tests-Answer Booklets and any other materials or resource books needed for this school year in full and in advance. I am hereby obligated to monitor my child's academics and report testing scores to the Academy each 9 weeks. If needed Gateway Christian Academy will notify me of any further materials required.
Father/Legal Guardian _________________________________________________
Mother/Legal Guardian ________________________________________________
