Christian Worldview Academy
Admission Form
Student's Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Mailing Address (fill out only if different from Residential Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Last School
*
Reason for Leaving Last School
*
Parent/Legal Guardian Name (Primary Contact person)
*
First Name
Last Name
Parent/Legal Guardian Occupation
*
Parent/Legal Guardian Email
*
example@example.com
Phone Number of Primary Contact
*
Please enter a valid phone number.
Parent/Legal Guardian Name (if two parents are in the same household)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Emergency Contact
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Attach Copy of Student Withdrawal Form
*
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Attach Copy of Final Report Card
*
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Attach Copy Immunization Record
*
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Attach Proof of Residency: (Utility bill, lease agreement, mortgage statement)
*
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Attach Guardianship/Custodial Document (If Applicable)
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Attach Birth Certificate (Must see physical copy at time of acceptance)
*
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Submit Application
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