Blue Mountain Academy Application

Blue Mountain Academy Application
Welcome to the Blue Mountain Academy online application. For your convenience, you do not have to complete this application all in one sitting. You may save it for later, and come back to make changes until you hit the Submit button.

Make the application as complete as possible. If you know the information that is requested even though it is not marked as required, please fill it in. The application will not be accepted with required fields missing.

Part of the application process includes submitting a $20 application fee. This can be done with a credit card below, or by sending it separately by mail.

Thank you for applying to BMA. If you have problems with this form, please contact Enrollment Services at 484-662-7007.

Paper application forms are still accepted via the mail. They can be found on our website.
Applicant Information

Please complete the form below.
Student's full legal name*

First NameMiddle NameLast Name
Preferred name (nickname)
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home phone number*

Area CodePhone Number
Student's cell phone number

Area CodePhone Number
Student's e-mail*
Applying for grade:*
Applying for school year:*
Area of residence*
MaleFemale
Date of birth*

MonthDayYear
Current age
City, State, and Country of birth*
Hair color*
Eye color*
BMA asks for the student's Social Security number for purposes relating to the work-study program.
Social Security number*
Re-enter Social Security number*
Church denomination*
Name of home church*
Conference of home church*
Please submit a recent photo of the student*

Upload a File

Cancelof
Family Information
MarriedDivorcedSeparatedNever MarriedWidowed
Who has custody*
NoYes
If adopted, at what age?
With whom does the student live?*
Please list the relationship of all those who live in the same household.
Please list names and birthdates of siblings
Sibling 1 name

First NameLast Name
Sibling 1 birth date

MonthDayYear
Sibling 2 name

First NameLast Name
Sibling 2 birth date

MonthDayYear
Sibling 3 name

First NameLast Name
Sibling 3 birth date

MonthDayYear
Sibling 4 name

First NameLast Name
Sibling 4 birth date

MonthDayYear
Mother's Information
LivingDeceased
Mother's name*

PrefixFirst NameLast Name
Mother's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mother's home phone

Area CodePhone Number
Mother's cell phone

Area CodePhone Number
Mother's e-mail
E-mail is BMA's preferred method of communication
Mother's occupation
Mother's employer
Mother's work phone

Area CodePhone Number
Mother's church denomination
Father's Information
LivingDeceased
Father's name*

PrefixFirst NameLast NameSuffix
Father's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Father's home phone

Area CodePhone Number
Father's cell phone

Area CodePhone Number
Father's e-mail
E-mail is BMA's preferred method of communication
Father's occupation
Father's employer
Father's work phone

Area CodePhone Number
Father's church denomination
Educational Information

Please list all schools attended since, and including, the 8th grade.
8th grade school year*
8th grade school name*
8th grade school address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
8th grade school phone*

Area CodePhone Number
8th grade graduation date*
9th grade school year
9th grade school name
9th grade school address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
9th grade school phone

Area CodePhone Number
10th grade school year
10th grade school name
10th grade school address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
10th grade school phone

Area CodePhone Number
11th grade school year
11th grade school name
11th grade school address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
11th grade school phone

Area CodePhone Number
Academic Information

This section should be completed by a Parent or Guardian.
IEP504 PlanPsychological ReportBehavior Plan
If your child has any of the documents listed above, please have them sent to BMA, ATTN: Learning Specialist, 2363 Mountain Rd., Hamburg, PA 19526:

The most current IEP, Section 504 Plan, all psychological reports, behavior plan, and the last two diagnostic or achievement test results (ex: ITBS scores, state test scores, etc.)
NoYes
If so, which grade(s)?
NoYes
If so, which one?
What subjects are areas of weakness for your child?

How well does your child read?*

	1	2	3	4	5	6	7	8	9	10

1 is Poor, 10 is Excellent

I understand that by submitting this application, I am giving Blue Mountain Academy permission to receive my child’s cumulative psychological file from all previously attended schools. I also understand that if I have hidden or withheld any academic information that would hinder Blue Mountain Academy from fully servicing my child’s disability, my child may be asked to withdraw.
Parent/Guardian Name*
This acts as a legally binding signature.
Initials*
Date*

MonthDayYear
Parent Commitment

Please read and "sign" below.
I agree to the conditions herein stated, and I am in harmony with the regulations and policies of Blue Mountain Academy (BMA) as stated in the school bulletin.

I have carefully considered the financial information in the current BMA school bulletin and agree to assume the financialresponsibility for the applicant. I understand that in addition to the down payment due on registration day, there will be nine more installments charged to the account from August through April. The balance due each month after student credit is applied is payable to BMA by the 20th of the following month. I understand that my student’s account with BMA must be paid in full before the diploma or transcript can be made available.

Physical and dental examinations must be completed by your personal doctors. Physical exams for new students and 11th graders need to be scheduled no more than four (4) months prior to the student’s first day of school. Consent forms for emergency care must be signed for any treatment of a minor. Immunization records must be on file at BMA in order for your child to attend school.

BMA is dedicated to a work program that carries as much importance as academic involvement in the student’s daily experience.

Work opportunities at BMA have been developed on the philosophy that manual training is essential to man’s development of character. My signature indicates my support of the school’s work program.

It is the policy of BMA to release directory information upon written request to other Seventh-day Adventist Institutions and for work verification. This information may include a student’s name; address; telephone number; date and place of birth; awards and honors; and attendance information. BMA reserves the right to use this information as deemed necessary.

I understand that a face-to-face interview is required before the application and acceptance process is complete. (Please contact BMA to set up this interview at a time that is convenient for you. We will do our best to accommodate your request.)
Parent/Guardian Name*
This acts as a legally binding signature.
Initials*
Date*

MonthDayYear
Spiritual Information

This section should be completed by the Student.
YesNo
YesNo
YesNo
If so, when?
YesNo
How would you describe your relationship with Jesus?*
Please explain
Social Information

This section should be completed by the Student.
How did you learn about BMA?*
Who would you like as a roommate?
What musical instruments do you play?*
What sports do you play?*
What are some of your hobbies?*
Behavioral Information

This section should be completed by the Student.
NoYes
If so, when last?
NoYes
If so, when last?
NoYes
If so, when last?
NoYes
If so, when last?
NoYes
If so, when last?
NoYes
If so, when last?
If so, why?
NoYes
Work Opportunities
Blue Mountain Academy requires all students to work. Jobs are assigned, as available, by the work coordinator.

Students are encouraged to work at Campus Industry, which employs the most students at BMA. Students needing to earn a greater portion of their school expenses or those receiving financial aid may be required to work at Industry. Students who work at Industry will earn minimum wage or better, and Industry students can work 3 or more hours per school day.

Students at jobs other than Industry are limited to 2 hours per school day.

Mark your top THREE work area choices.

Rows	Order of Choice
Industry
Administrative Offices
Cafeteria
Computer Support
Custodial
Dorm
Maintenance
Music
Teacher Assistant

List any job experience you have:
NoYes
If so, what date are you able to begin?
Student Commitment

This section should be completed by the Student.
I have read and fully understand the regulations and principles of Blue Mountain Academy. If accepted, I hereby agree to obey the policies of the school, to do my best at my assigned job, and to cooperate in upholding the standards of the institution.
Student Name*
This acts as a legally binding signature.
Initials*
Date*

MonthDayYear
Student Statement

This section should be completed by the Student.
Blue Mountain Academy’s goal is to encourage young people to experience a personal relationship with Jesus Christ while helping them reach their full academic potential. To help us make this experience possible for you and the rest of our students, we would like to get to know you better.

Please write a personal statement in the space provided below (minimum of 75 words) that outlines (1) why you would like to attend Blue Mountain Academy, (2) what contributions you feel you can make to our student body, and (3) where you currently are in your spiritual life and personal relationship with Jesus Christ.
Please type your statement here:*
Application Fee
Application Fee
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Pay Application Fee Now with PayPal or Credit Card$20.00

I will send the Application Fee separately.$ Free

Total $0.00
Enter the message as it's shown*
Print and Submit Your Application

We highly recommend that you print this form for your records. Sometimes transmission errors occur, and it is always helpful to have a back-up hard copy.
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Blue Mountain Academy Application

Applicant Information

Family Information

Mother's Information

Father's Information

Educational Information

Academic Information

Parent Commitment

Spiritual Information

Social Information

Behavioral Information

Work Opportunities

Student Commitment

Student Statement

Application Fee

Print and Submit Your Application