Application Form

Eastgate Academy is founded on Biblical truths. Parents/Guardians of our Eastgate Academy students must have read and agreed to our Statement of Faith.

Statement of Faith

We believe the Bible to be the inspired and inerrant Word of God. We believe in the virgin birth of Jesus Christ, his death as a substitution for our sins, and his bodily resurrection and ascension into heaven.

There is one God, who has revealed Himself as Father, Son and Holy Ghost. Jesus Christ is God manifested in flesh. He is both God and man. (See Deuteronomy 6:4; Ephesians 4:4-6; Colossians 2:9; I Timothy 3:16).

We believe in the Biblical plan of salvation, detailed in Acts 2:38, which is repentance, baptism by water-immersion in the name of Jesus Christ for the remission of sins, and the infilling of the Holy Ghost evidenced by speaking with other tongues.

We believe in the Second Coming of Jesus Christ and anticipate eternal life with Him. As Christians we are to love God and others. We should live a holy life inwardly and outwardly, and worship God joyfully. The supernatural gifts of the Spirit, including healing, are for the church today (See Mark 12:28-31; II Corinthians 7:1; Hebrews 12:14; I Corinthians 12:8-10). We believe regular church attendance and involvement are essential for all believers (Hebrews 10:25).

We believe that God wonderfully and immutably creates each person male or female. Rejection of one’s biological sex is a rejection of the image of God within that person. Gender distinction is essential to godly living. There should be a clear difference between men and women regarding their appearance and apparel (I Corinthians 11:14-15, Deuteronomy 22:5).

We believe that the term marriage has only one meaning: the union of one man and one woman in a single, exclusive, lifelong relationship, as detailed in Scripture. We believe that God intends sexual intimacy to occur only between a man and a woman who are married to each other.

This statement of faith does not exhaust the extent of our beliefs. The Bible itself is the sole and final source of all that we believe. For the purposes of Eastgate Academy’s faith, policies, and procedures, decision-making authority concerning the application of Scripture shall be vested in the school’s board.

These standards impact all ministry of Eastgate Academy, including, but not limited to, facility use, the hiring and retention of staff and volunteers, and the evaluation of current and prospective students.

I have read and agree with the Statement of Faith*

I agree

I am a tithe-paying member of Eastgate United Pentecostal Church*

YesNo

To be eligible for the Eastgate Member rate you must:

Regularly attend Sunday & Wednesday services at Eastgate Church
Pay tithe to Eastgate Church
Complete Eastgate University

If you have questions about how to become a member, please call or email us.

I agree with the stated beliefs of the United Pentecostal Church International (beliefs found at www.upci.org) and consider myself Apostolic Pentecostal (At this time, Eastgate Academy only accepts applications from Apostolic Pentecostal students/parents)*

YesNo

Please select all that apply (For Parent/Guardian)

I have repented of my sinsI have been baptized in Jesus' NameI have received the gift of the Holy Ghost, evidenced by speaking in other tonguesI have completed Eastgate UniversityI am faithful in tithe and offering at my local church

As we believe regular church attendance and involvement are essential for all believers, we would like to know a little more about your home church.

I am a regular member of the following church:

Name of Church

Pastor's Name:

APPROVAL PROCESS
All applications are reviewed before a student is approved for Enrollment. All applicants are subject to Placement Testing before being approved for Enrollment.

APPLICATION FEE
The Application Fee is $100 and is due with the application form. This fee is non-refundable. (After July 13th, Application Fee will be $150).

Primary email where you would like communication sent:*

example@example.com

Student Information

Name*

First NameMiddle NameLast Name

Preferred Nickname

Optional

Birth Date*

MonthDayYear

Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

With whom does the student live?*

First NameLast Name

Relation to student*

Student's 2025-2026 School Year Grade Level*

K3 NOTICE: Unfortunately, due to the large number of applicants, we are unable to accept anymore students into this class.

We do have a waiting list, to be added, please click here: WAITING LIST

We apologize. This class is full.

Eastgate Academy defines "fully potty-trained" as follows:

The child independently asks to go to the bathroom when needed (and/or sits themselves on the potty when the entire class is brought to the bathroom as a group.) In addition, being able to wipe themselves, flush, wash hands. Occasionally, even a "fully potty-trained child" will have an accident.

Your child must be fully potty-trained in order to attend Eastgate Academy.*

I understand

My child has attended another school outside of homeschool:*

YesNoThis is my child's first year of school

Name of Most Recent School Attended

Contact Number*

Area CodePhone Number

I do hereby consent to Eastgate Academy contacting any previous schools attended.

Parent Information

Parent/Guardian 1 Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Contact Number*

Area CodePhone Number

Employer*

Hours

Work Phone

Area CodePhone Number

Parent/Guardian 2 Name

First NameLast Name

Birth Date

MonthDayYear

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Contact Number

Area CodePhone Number

Employer

Hours

Work Phone

Area CodePhone Number

If someone other than a parent has custody, please complete this section:

Person with legal custody

First NameLast Name

Birth Date

MonthDayYear

Relationship to student

Family Information

Does the student have any siblings*

YesNo

Sibling 1

First Name

Last Name

Age

Gender

MaleFemale

Does this sibling live with the student?

YesNo

Current Grade

Additional siblings?

YesNo

Sibling 2

First Name

Last Name

Age

Gender

MaleFemale

Does this sibling live with the student?

YesNo

Current Grade

Additional siblings?

YesNo

Sibling 3

First Name

Last Name

Age

Gender

MaleFemale

Does this sibling live with the student?

YesNo

Current Grade

Are there other people living in the home?

YesNo

1st additional household member

First Name

Last Name

Age

Gender

MaleFemale

Relationship to student

Grade Completed (Most recent educational status)

Are there other people living in the home?

YesNo

2nd additional household member

First Name

Last Name

Age

Gender

MaleFemale

Relationship to student

Grade Completed (Most recent educational status)

Are there other people living in the home?

YesNo

3rd additional household member

First Name

Last Name

Age

Gender

MaleFemale

Relationship to student

Grade Completed (Most recent educational status)

Please list any additional household members below:

Student History

Does your student receive continuing medical care for a special condition?*

YesNo

Please explain:

Does your student see a doctor regularly for this condition?

YesNo

Doctor's Name:

Does your student use any medical device (i.e. wheelchair, hearing aid, etc.)*

YesNo

Please list:

Does your student take medication regularly?*

YesNo

Please list medications:

Has your student ever been hospitalized?*

YesNo

For what and when?

Has your student ever been assessed for a learning disability?*

YesNo

For what and when?

Has a teacher, doctor or nurse ever told you that your student has any of the following problems? Please select all that apply:

Does your child have tempter tantrums or otherwise lose control?*

YesNo

Please explain when this happens:

Please list any concerns you may have about your student's behavior:

Family History

Is there anyone in your household with a physical condition that requires medical treatment or medication?*

YesNo

Is there anyone in your household who participated in counseling or mental health services?*

YesNo

Have you or a family member been a victim of violence?*

YesNo

Have you or a family member ever received treatment for substance abuse?*

YesNo

Is there anyone in the family in jail or on probation (current or past)?*

YesNo

Are there any other programs or community providers that you or your family are involved with?*

YesNo

Please list:

Does either parent (or guardian) have difficulty reading or did either have learning problems in school?*

YesNo

What is the language usually spoken at home by parents:*

Language usually spoken by child:*

Please list any other family concerns you think we should know about:

Additional comments:

K5 - 12TH GRADE TUITION RATES

Students Enrolled Per Family	Annual	Monthly	Eastgate Member Annual	Eastgate Member Monthly
1st Student	4500	450	3000	300
2nd Student	4000	400	2500	250
3rd Student (and additional students)	3500	350	2000	200

K3 - K4 TUITION RATES

Students Enrolled Per Family	Annual	Monthly	Eastgate Member Annual	Eastgate Member Monthly
1st Student	5500	550	3500	350
2nd Student	5000	500	3000	300
3rd Student (and additional students)	4500	450	2500	250

EARLY WITHDRAWAL

Enrollment is an annual commitment – tuition is due in full for each enrolled student, even with early withdrawal.

BOOK FEE

GRADE	AMOUNT
Preschool	$130 per student
Kindergarten	$195 per student
1st - 5th	$360 per student
6th - 8th	$320 per student
9th - 11th	$360 per student + electives
12th	$200 per student + electives
Electives	TBD

SCHOOL HOURS

Monday - Thursday / 8:00am - 4:00pm

UNIFORMS

Eastgate Academy students will adhere to a uniform policy. This policy is outlined in the Parent Handbook.

FIRST MONTHLY SCHOOL BILL

Your first monthly school bill is due on August 17th.

TUITION PAYMENTS

Monthly bills are due no later than the 17th of each month, beginning August 17th and ending May 17th.

Automated tuition payments are a requirement in order to attend Eastgate Academy.

PAST DUE ACCOUNTS

We understand, even with automated payments, challenges can arise - If your full monthly payment is not received by the 17th of the month there will be a $25 late fee added to your account monthly until your account is up to date.

If you have not paid your school bill in full by the last day of the month, your child will not be allowed to return to school on the first day of the next month.

The school depends on the cooperation and dependability of parents to keep the school operating. While we try to accommodate and understand financial hardships, the school will follow these guidelines as it relates to past due accounts:

No child will be allowed to return to a new school year with a past due account from the previous school year.
Your child's transcripts, records and grades will not be released until the account is paid in full.
Graduating seniors will not receive their diploma or transcript until the school account is paid in full. For graduating seniors, school accounts must be paid in full ten (10) business days prior to graduation.

IN ORDER TO SOLEMNIZE the desire of the undersigned parties to glorify the Lord with their obedience to Him and to promote a clear understanding of the duties and responsibilities of each party, the undersigned parties adopt the following agreement:

I, the Parent/Guardian, for and in consideration of my child, being admitted as a student at Eastgate Academy, do hereby accept such admission and the duties and responsibilities entailed therein and agree to be bound by the terms of this Agreement:

I faithfully attend services and take an active part in the total church program. I agree to be loyal to the pastor and the church programs in word and in deed. I agree to fulfill all duties and responsibilities of my membership at my local church.
I understand and agree that the church and the school ministry are inseparable and that my child may be expelled from the school if either of us is out of fellowship with the church, as determined in the sole discretion of the pastor and the church leadership.
I agree to support Eastgate Academy with my conduct and my prayers.
I understand and agree that the education of my child will be guided by the school staff and administration. I agree that my purpose in obtaining a Christian education for my child will be achieved by following the curriculum set by the staff and administration.
To that end, I agree that I will require my child to perform all duties and responsibilities entrusted to him by the staff and administration to the best of his/her ability to their satisfaction.
I will support the decisions of the staff and administration and will not attempt to undermine their authority.
I understand and agree that during my child's enrollment the courses offered and the staff teaching them may change from time to time in the discretion of the school administration.
I understand and agree that my child has no right to publish and distribute a student newsletter or any other publication. I understand and agree that Eastgate Academy and Eastgate United Pentecostal Church, has the right, in its sole discretion, to control what is published, circulated, or otherwise distributed at its school to its students or staff, and I will ensure that my child understands this provision.
I understand and agree that attending Eastgate Academy is a privilege and the school reserves the right to suspend or expel my child from the school in accordance with its official policies as determined by the school.
I agree to pay all tuition and fees in the manner as set forth in this document. I understand that monthly tuition payments are due on the seventeenth (17) day of each month. I understand that this will be an automated draft. I further understand that if I fail to make a timely payment, my child may be withdrawn from school and I may be subject to late-payment fees and other costs, including any necessary costs of collection in accordance with school policy.

I, the parent/guardian, have read and agree to the all above terms and conditions*

I agree

Required ACH information for tuition payments.*

I would like to use my debit/credit card to pay the monthly tuition installments on the 17th of every month. I understand that a 5% processing fee will be added to the monthly tuition.I would like to have the monthly tuition installments withdrawn from my bank account on the 17th of every month.I would like to make a one time payment for the full years tuition using cash or check by August 17th.

Application Fee*

USDThis fee is nonrefundable

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Upon submission you agree that you understand the information on this application will only be used to help determine your student’s eligibility for Eastgate Academy and will not be released to anyone other than necessary personnel.

APPLICATION

K5 - 12TH GRADE TUITION RATES

Students Enrolled Per Family

Annual

Monthly

Eastgate Member Annual

Eastgate Member Monthly

K3 - K4 TUITION RATES

Students Enrolled Per Family

Annual

Monthly

Eastgate Member Annual

Eastgate Member Monthly

EARLY WITHDRAWAL

BOOK FEE

SCHOOL HOURS

UNIFORMS

FIRST MONTHLY SCHOOL BILL

TUITION PAYMENTS

PAST DUE ACCOUNTS