Prospective International Student Information Form 2025

Directions: Please review the information below and complete it to the best of your ability. If there are any questions, concerns, or issues of any kind, please reach out to our International Director, Gib Killion, via email at gkillion@nebraskachristian.org.
General Student Information
Student’s LAST Name
Student’s FIRST Name
Student’s MIDDLE Name
Student’s PREFERRED Name
Check all that apply

Both ParentsFather is DeceasedMother is DeceasedParents are SeparatedFather has CustodyMother has CustodyParents are DivorcedOther
Father’s Name
Father’s Profession
Mother’s Name
Mother’s Profession
Student’s Age
Student’s Birthdate

MonthDayYear
Date
Student's Place of Birth
City, Country
Student’s Biological Sex

MaleFemale
Student’s Citizenship Location
Country
Does the student have a passport?

YesNo
If the student has a passport, please upload a picture of it below.
File Upload

Cancelof
Student's Contact Information
Student’s Phone Number
Student’s Email Address
example@example.com
Student's Street Address

Please complete this section in its entirety
Street
District
City
Providence
Country
Postal Code (if applicable)
Student’s Academic Information
What grade is the student applying for?
What grade is the student currently in?
What year does the student wish to enroll in at Nebraska Christian?
Name of Previous School
Previous School’s Email
example@example.com
Previous School’s Address
List and English Test Scores
Examples: ILETS, TOEFL
Will the student be enrolled in ESL?

YesNo
If YES, which level?

BeginningIntermediateAdvanced
Has the student ever been referred for academic evaluation, either remedial or accelerated?

YesNo
If YES, please explain below
Has the student received their academic transcripts from their previous school?

YesNo
If you responded yes, please provide a picture of your transcripts below.
File Upload

Cancelof
Student Medical Information
Has the student ever consulted, or been referred to a psychologist, psychiatrist, or social worker for professional assistance?

YesNo
If YES, please describe the circumstances
If the student has used or had experience with any of the substances below in the last 12 months, please check the circle below.

Narcotic Drugs, Tobacco, Alcoholic Beverages, Stimulants, or other illicit substances.
If any of the above were selected, please provide an explanation
Please list any medication(s) the student is currently taking
Please list any medical condition(s) the student has
Signature of Student and Parent
Student, please type your full name, indicating that the information you have provided is true and accurate to the best of your knowledge.
Student's Signature

Powered by Jotform SignClear
Parent, please type your full name, indicating that the information you have provided is true and accurate to the best of your knowledge.
Parent's Signature

Powered by Jotform SignClear
Thank you for taking the next step to learn more about our International Student Program. We are grateful for your interest in Nebraska Christian Schools and will be in contact with you shortly.

Gib Killion International Director

After you have finished filling out this form, please press the “submit form” button found at the bottom of the page.
Should be Empty:

General Student Information

Student's Contact Information

Student’s Academic Information

Student Medical Information

Signature of Student and Parent