Application Form

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 churchI attend Eastgate Church

RE-ENROLLMENT PROCESS

Students are not guaranteed re-enrollment. All forms are reviewed before a student is approved.

Eastgate Academy expects parents/guardians and students to accept the terms of the Student Handbook.

The re-enrollment Fee must accompany this form before the approval process may begin. No student is eligible for re-enrollment if the student account has a past-due balance.

Note: Re-enrollment fees are non-refundable.

FEE
The non-refundable re-enrollment fee is $75 for the first child and $50 for each additional child. After April 12, re-enrollment will be $100 for the first child and $75 for each additional child.

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 2024-2025 School Year Grade Level*

Would you like to re-enroll additional students?*

YesNo

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 Code

With whom does the student live?*

First NameLast Name

Relation to student*

Student's 2024-2025 School Year Grade Level*

Would you like to re-enroll additional students?*

YesNo

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 Code

With whom does the student live?*

First NameLast Name

Relation to student*

Student's 2024-2025 School Year Grade Level*

Would you like to re-enroll additional students?*

YesNo

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 Code

With whom does the student live?*

First NameLast Name

Relation to student*

Student's 2024-2025 School Year Grade Level*

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

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

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

Additional comments:

Reasons Eastgate Academy is important..

How has Eastgate Academy benefited by child

To receive Eastgate Member Rates, email finance@eastgateupc.org and request your tithe paying code. This will be entered on the Tuition Form.

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

PRESCHOOL 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 FEES

Due by July 31st

GRADE	AMOUNT
Preschool	$120 per student
Kindergarten	$185 per student
1st - 5th	$360 per student
6th - 8th	$320 per student
9th - 11th	$360 per student + electives
12th	$160 per student + electives
Electives	TBD

SCHOOL HOURS

Monday - Thursday / 8:30am - 3:30pm

UNIFORMS

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

FIRST MONTHLY SCHOOL BILL

Your first monthly school bill is due on August 17th. ALL fees are non-refundable.

TUITION PAYMENTS

Monthly bills are due each month 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 25th of the month there will be a $25 late fee added to your account.

If you have not paid your school bill in full by the last day of the month, your child will not be able 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 diplomas 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 am a faithful church member, attending services and taking 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 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 tuitionI 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.

Number of re-enrollees *

AMOUNT DUE: $75

AMOUNT DUE: $100

AMOUNT DUE: $175

AMOUNT DUE: $250

AMOUNT DUE: $325

AMOUNT DUE: $400

Payment amount*

USDEnter the amount due according to the number of enrollees.

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

Signature*

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.

Re-Enrollment Form

K5 - 12th GRADE TUITION RATES

Students Enrolled Per Family

Annual

Monthly

Eastgate Member Annual

Eastgate Member Monthly

PRESCHOOL TUITION RATES

EARLY WITHDRAWAL

BOOK FEES

UNIFORMS

FIRST MONTHLY SCHOOL BILL

TUITION PAYMENTS

PAST DUE ACCOUNTS