Request for Application
Christ Academy Middle School
Parent Name:
*
First Name
Last Name
Phone Number:
*
-
Area Code
Phone Number
Email Address:
*
Email
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Name:
*
First Name
Last Name
Age:
*
Previous school attended:
*
Please Select
Newport Elementary, 1700 Commerce Blvd., Newport, AR 72112
Newport High School, 406 Wilkerson Dr., Newport, AR 72112
Swifton Middle School, 300 Ashley Ave, Swifton, AR 72471
Other
If other, please add the name and address of the previously attended school.
*
Dates Attended:
*
(ex. 08/2021 to 05/2024):
Choose the grade your child will be entering for the 2024-2025 school term.
*
sixth grade
seventh grade
eighth grade
Is the student able to work at grade level and actively participate within their own age group?
*
Yes
No
If NO, please explain:
Please add any additional information you would like to provide.
Submit
Should be Empty: