GPCA 25/26 Application

GPCA Application

2025/26 School Year
Tuition & Fees Schedule
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Student Social Security # (opt.)
Gender*

MaleFemale
With whom does the student live?*
Student's 2025/26 School Year Grade Level*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Last Attended*
Previous School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Information
Parent/Guardian's Name - Primary*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Employer
Work Phone Number
Parent/Guardian's Name - Secondary

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Employer
Work Phone Number
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person*

First NameLast Name
Emergency Phone Number*
Please enter a valid phone number.
Family Information
Brother/Sister Name
Does this sibling live with the student?
Brother/Sister Name
Does this sibling live with the student?
Brother/Sister Name
Does this sibling live with the student?
Student History
Does your student receive continuing medical care for a special condition?*

NoYes (Please explain when this happens.)
Does your student see a doctor regularly for this condition?

NoYes (Please provide doctor's name.)
Does your student us any medical device (I.e. wheelchair, hearing aid, etc.)?*

NoYes (Please list what they use.)
Does your student take any medications regularly?*

NoYes (Please list medications.)
Has your student ever been hospitalized?*

NoYes (For what, and when?)
Does your student have temper tantrums or otherwise lose control?*

NoYes (Please explain when this happens.)
Does your child have any allergies? (If your student needs an EpiPen/medication to stay at school, documentation will need to be provided in case of an allergic reaction.)*

NoYes (Please list.)
List any concerns you have about your student's behavior:
Kindergarten History
Has your child been in preschool?

NoYes (List when and where.)
Does your child speak in sentences?

NoYes
Can others understand what your child says?

NoYes
Are there any problems with your child's speech?

NoYes (Please explain.)
Does your child play well with other children?

YesNo (Please explain.)
How often does your child play with other children his/her age?
Family History
Is there anyone in your household with a physical condition that required medical treatment or medication?

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

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

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

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

NoYes
Does either parent have difficulty reading or did either have learning problems in school?*

NoYes
What is the primary language spoken at home?*

EnglishSpanishOther
What language is primarily spoken by the child?*

EnglishSpanishOther
Please list any other family concerns that you think we should know about:
File Upload

A copy of the student's birth certificate, report card from the previous school and immunization record is required for registration.
Upload
Reminders
TEST. GPCA may require new students or a transferee to take a math and language test to see where they place and their levels.

INTERVIEW. The school admin will conduct an interview with the student and parents/guardians prior to admittance.

REQUIREMENTS. It is important to complete all requirements before school starts. Failure to do so may delay the student from coming to school.

BEHAVIOR. A recommendation letter is may be requested to get admitted to GPCA. This could be from a pastor, teacher, or authority figure.
Enrollment Form and Signature
Date Signed*

MonthDayYear
Date
Parent/Guardian Signature*

Clear
Print Name*

First NameLast Name
Should be Empty:

GPCA Application

Tuition & Fees Schedule

Parent/Guardian's Information

Family Information

Student History

Kindergarten History

Family History

File Upload

Reminders

Enrollment Form and Signature