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Student Application Form

 

STUDENT APPLICATION FORM

Please use one Student Application Form for each child you are enrolling.

Student Information:                                               * Required Fields

    Student’s First Name *                   Student's Middle Name                         Student's Last Name * 
                   

      Birthdate* 
  mo/day/yr                             
                                                               
                    
      
Gender*     Male    Female

   Last Grade Completed*                  Current Grade*                  
                                                                   

                                                                                          

                                                                                      
 
Please enter any pertinent information concerning your child and his/her educational needs


 
Previous School Information:

                  Last School Attended*


                          City *                                 State*
          

                  
Last Date Attended (Approx.) *

                    
mo/day/yr   

 
   
Race/Ethnicity
*                                                                                 
American Indian or Alaskan Native
Asian

Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Other

Parent Information:

Enter N/A in any field for a person that is not living in the home.

   Father’s First Name*                    Father's Last Name*                     
         
Father's Relation to Student*
Father
Step-Father
Guardian

   Mother’s First Name *                  Mother's Last Name*             

        
Mother's Relation to Student *
Mother
Step-Mother
Guardian

Marriage Status of Parents:*
      Married       Single Parent      Divorced      Domestic Partners      Separated**

**If separated, both parents/guardians must sign the Parent Agreement at the bottom of this form. The other parent may give consent by email.

Shipping Address * Not a Post Office Box                                                        


                                City*                             State *           ZIP Code*
              

Mailing Address * 


                                City*                             State *           ZIP Code *
               

Home Phone* Cell Phone
Use numbers only......... Example: 7714445512 ........No dashes & No ( )
Work Phone Ext.   Mother's  Father's

Email Address * If none, type "None"

Do you have a High Speed Internet connection? Yes     No

Curriculum Preference:
Please indicate if you prefer computer-based curriculum or workbook-style curriculum. There are advantages to both. You may even combine the two. In any case, you may want to call and discuss the advantages of either with one of our Education Specialists. Remember, there is an extra cost for the computer-based curriculum and is only available in the Full Year Payment option. The extra cost is an additional $15 per course per year.
Workbook-style
Computer-based - If so, what type of required back-up do you have for your computer? ie: USB Hard Disk Drive, Thumb Drive, Carbonite, Mozy, Barracuda
Combination of Workbook-style and Computer-based - If so, what type of required back-up do you have for your computer?

ie: USB Hard Disk Drive, Thumb Drive, Carbonite, Mozy, Barracuda

 

Registration Fee:
.Registration Fee: (One Time Fee)..(Choose one)...................................... *
1. Kindergarten - 3rd grade: $35.00 or
2. 4th - 8th grade (Includes Diagnostic Testing & Placement): $50.00 or
3. 9th - 12th (9th & 10th includes Diagnostic Testing & Placement): $75.00

Tuition Fee:
Tuition Fee: (See Registration & Fees for options)...................................

Total Fees:
Total Fees (Add Registration & Tuition Fees)............................................. *


Payment Details:
You may confidently e-mail this Application with your credit card information.
If you are not submitting card information, type N/A in each field. C.A.A. does not accept personal checks.

Type of card:            VISA            MASTERCARD

Account # *

Expiration date  *    Security code *

Name on Account *

Billing Address *

City *     State *   ZIP Code *

 
  * Required Fields

Parent Agreement Form

We have reviewed the Student Application and to the best of our knowledge, all information provided is complete and accurate.

We understand that we are responsible for the tuition payment, which provides for all necessary curriculum assignments, parent answer keys, report cards, and permanent record file. We further understand that some courses require reference books, which are an extra cost. We understand that the application fee is a one-time payment and is non-refundable. We have read and understand the refund policy of the Academy.

We understand that a school year is a maximum of 12 months, beginning on the date of enrollment and ending when the student has completed all curriculum assignments. If enrolling from another school during a school year, we understand that the school year start date is the start date of the previous school and curriculum assignment adjustments will be made by the Academy staff.

We understand that if we choose the quarter tuition payment, it provides for (1/4) one quarter of the school year of materials and should be completed within (3) three months. We understand that a student is placed on the Inactive Roll if we do not send another tuition payment within the three month period and that a Reactivation Fee of $5.00 will be assessed to reactivate our child in the Academy. We further understand that if we do not reactivate our child within (3) three months of his/her Inactive Roll status, our child will not be allow to return to the Active Roll of this Academy and we will need to seek other educational alternatives. We also understand that if our child is placed on the Inactive Roll more than (2) two times and accumulates more than (4) four months of Inactive Roll status in one school year, our child will not be allowed to return to the Active Roll of this Academy and we will need to seek other educational alternatives. We further understand that if completed assignments are returned after exceeding the Reactivation deadline, the Academy will assess an Extension Fee of $25.

We understand that if we choose the full year tuition payment, it provides for one school year of materials and should be completed within (12) twelve months. We understand that a student is placed on the Inactive Roll if we do not send another tuition payment within the twelve month period and that a Reactivation Fee of $5.00 will be assessed to reactivate our child in the Academy. We further understand that if we do not reactivate our child within (3) three months of his/her Inactive Roll status, our child will not be allowed to return to the Active Roll of this Academy and we will need to seek other educational alternatives. We further understand that if completed assignments are returned after exceeding the Reactivation deadline, the Academy will assess an Extension Fee of $25.

We understand that our child is to be under direct adult supervision during study time and that the supervising adult has read and understands the Academy procedures. We agree that the supervising adult will submit our responses to the Academy's Required Response Forms that are sent to us via email or regular mail.  We further understand that the supervising adult will require that the student adhere to the Academy procedures, including, but not exclusive of, copying answers from the Score Keys or Test Keys and by keeping the Test Keys in a secure location. We agree to submit completed and graded Tests at the end of the first month of enrollment and at the end of each semester term. We understand that Christian Academy of America reserves the right to withdraw students  and withhold grades of any student that is found to be in non-compliance of Academy procedures.

We understand that if we are using the computer-based curriculum that we are required to have a back-up disk for the data and that the back-up of the data will be performed on a weekly basis at least. We further understand the requirement of anti-virus software and will ensure that the anti-virus software is updated daily.

By entering our names in the Signature boxes, We understand and agree with the above statements and also verify the information entered is correct to the best of our knowledge.

Student's Signature: *

Father / Guardian Signature: *  

Mother / Guardian Signature: * 

Name of Parent, Guardian, or Supervisor responsible to administer this home school program:
*
If this is a person other than the Parent or Guardian, please provide the relationship to the student:

*

If desired, please list the names of any other relatives or non-family persons and their relationship to the student, with whom the student's Academic Advisor may discuss the student's academic information (tutors, grandparents, noncustodial parent, etc.).
              Name                                              Relationship

            Name                                              Relationship