2nd - 12th Grade Application

Click here for the PreK - 1st Grade Application

"*" indicates required fields

Student Information

Student Name*

First Middle Last

Nickname

To be used at school by peers & teachers

Address*

Street Address City State / Province / Region ZIP / Postal Code

Primary Phone*

Can the phone number listed above receive SMS messages (text)?*

Date of Birth*

Month

Day

Year

Male or Female?*

Male

Female

Is your child a U.S. citizen?*

Yes

I-95, Passport or Immigration Number*

Date of Entry*

Month

Day

Year

Current Grade*

Applying for Grade*

Academic Year*

Please list all schools the applicant previously attended starting with the most recent:*

Name of School

City/State

Phone Number

Grade(s)

Family Information

With whom does the applicant reside?*

Are there special child custody provisions?*

If yes, please provide documentation.

Yes

Child Custody Documentation*

Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Father/Male Guardian

Name*

First Last

Email*

Primary Phone*

Secondary Phone

Can the Primary Phone number receive SMS messages (text)?*

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Employer*

Employer Address*

Street Address City State / Province / Region ZIP / Postal Code

Church Now Attending*

Pastor*

Pastor’s Phone*

Church Attendance*

Regular

Sporadic

Seldom

Marital Status*

Spouse Living at Home

Separated

Divorced

Spouse Deceased

Mother/Female Guardian

Name*

First Last

Email*

Primary Phone*

Secondary Phone

Can the Primary Phone number listed above receive SMS messages (text)?*

Home Address*

Street Address City State / Province / Region ZIP / Postal Code

Employer

Employer Address

Street Address City State / Province / Region ZIP / Postal Code

Church Now Attending*

Pastor*

Pastor’s Phone*

Church Attendance*

Regular

Sporadic

Seldom

Marital Status*

Spouse Living at Home

Separated

Divorced

Spouse Deceased

Are there siblings in the home?*

Yes

What are their names and ages?*

Financial Information

Financial obligation for tuitions & fees goes to:*

Father Only

Both Parents

Mother Only

Are you interested in applying for financial assistance?*

Yes

If someone other than the parent/guardian listed above is responsible for the financial obligations while this student is enrolled at Mount Zion, please complete the following information:

Name

First Last

Relationship to Student

Address

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Work Phone

Cell Phone

Email Address

Education & History

Has the applicant ever been involved in a serious infraction of school rules that caused him or her to be suspended, withdrawn, or expelled from the school?*

Yes

If yes, list the offense(s), date(s), and consequences

Has the applicant had any history of excessive tardies or absences from school?*

Yes

If yes, explain:*

Has the applicant ever received public or private services for an identified learning disability?*

Yes

If yes, explain:*

Are there any medical diagnoses that could impact his or her success in a classroom environment?*

Yes

If yes, explain:*

Has the applicant ever been arrested?*

Yes

If yes, explain:*

Does the applicant have any history of health problems (physical or emotional)?*

Yes

If yes, explain:*

Is the applicant on medication?*

Yes

If yes, type(s)*

If yes, what is the intended result(s) of the medication(s)?*

Does the applicant have any type of learning disability, difficulty or limitations?*

Yes

If yes, explain:*

Does the applicant have any type of learning modification or individual education plan (IEP) – past or present?*

Yes

If yes, explain:*

Has any form of academic/executive functioning testing been done for the applicant in past years?*

Yes

If yes, what have been the results of the two most recent tests (include actual copies if possible):*

Test Results #1

Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Test Results #2

Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Is the applicant currently involved in any special programs or receiving any special services from your school or from a private source?*

If so, please provide documentation of services provided including dates of services rendered, past or present

None

Occupational Therapy

Speech Therapy

Reading Recovery

Physical Therapy

Special Education

Gifted Education/Enrichment

Other

If other, explain:*

If so, please provide documentation of testing, which was done to qualify the applicant.

Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Parent Information

Please write a paragraph or two to describe why you would like your son/daughter to attend Mount Zion Christian Schools:*

How did you hear about Mount Zion Christian Schools?*

Consent*

I understand it is my responsibility to ensure that all the appropriate recommendation forms, as listed below, are delivered to the appropriate individuals and that they have been completed and returned to Mount Zion Christian School in a timely manner.

Consent*

I have completed this student application truthfully, to the best of my knowledge and give permission for Mount Zion Christian Schools’ administration to call past and current teachers, tutors, administrators and/or pastors. I also certify that I have read the enclosed materials along with this application.

Father/Guardian Signature

Date

Month

Day

Year

Mother/Guardian Signature

Date

Month

Day

Year

Please list to whom you will be sending reference forms (grades 7 – 12 only).

Pastor or Youth Leader*

First Last

Pastor or Youth Leader Phone*

Academic Reference (teacher, principal, guidance counselor)*

First Last

Academic Reference Phone*