CCA Application for Enrollment 2026-2027

Application for Enrollment
Full Name of Parent / Guardian who is filling out this form.*

First NameLast Name
Email of Parent / Guardian who is filling out this form.*
example@example.com

Student Information
Student Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Grade Level*
Please note that if a grade is not listed it is because we are full.
IEP or 504 Plan - Please mark below if your student has an IEP or 504 Plan

IEP504 Plan
Please list any academic concerns that you have for your child. Please include a brief description any IEPs or 504 plans that the student may have or accommodations that your student may require. Type NA if you have no concerns.*
We require copies of IEP's or 504 plans prior to acceptance in our school. Please upload them, otherwise you will need to bring to the office when your student is accessed.

Cancelof
Has your child been expelled or asked to leave from any school?*

YesNo
Please list any emotional or behavioral concerns that you have for your child. Type NA if you have no concerns. *

Parent Information
Father / Guardian Name
Father / Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Father / Guardian Email
example@example.com
Mother / Guardian Name
Mother / Guardian Cell
Please enter a valid phone number.Format: (000) 000-0000.
Mother / Guardian Email
example@example.com
Please describe the student's family and current living situation.*

Student Records Request

Required for students in first grade and up.
School Student Last Attended*
School Address*
School Fax
Please enter a valid phone number.Format: (000) 000-0000.
School Records Email
example@example.com
Grades Student Attended School*
SIGNATURE
I hereby give my permission to send the complete records of my child to Cornerstone Christian Academy
Parent/ Guardian Signature*
Date*

MonthDayYear
Date

Parent / Guardian Signature & Payment
By signing below, I acknowledge that all data in this form is valid. I also understand that any false information in this form may forfeit my child's acceptance and enrollment in Cornerstone Christian Academy. *
Application Payment

Please note, this is an application and testing fee. When you submit this application and pay the application fee ($50), you will be contacted for testing. The testing appointment is included in this application fee.
Application Fee*
prevnext( X )
Application Fee
The fee covers the application fee and testing process.

$50.00

Total

$0.00
Enrollment Date

MonthDayYear
Date
Enrollment Code
School Year

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Application for Enrollment