CCA Application for Enrollment

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.
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.*
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