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  • About
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2nd - 12th Grade Application

Click here for the PreK - 1st Grade Application

"*" indicates required fields

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Student Information

Student Name*
To be used at school by peers & teachers
Address*
Date of Birth*
Male or Female?*
Is your child a U.S. citizen?*
Date of Entry*
Please list all schools the applicant previously attended starting with the most recent:*
Name of School
City/State
Phone Number
Grade(s)
 

Family Information

Are there special child custody provisions?*
If yes, please provide documentation.
Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Father/Male Guardian

Name*
Home Address*
Employer Address*
Church Attendance*
Marital Status*

Mother/Female Guardian

Name*
Home Address*
Employer Address
Church Attendance*
Marital Status*
Are there siblings in the home?*

Financial Information

Financial obligation for tuitions & fees goes to:*
Are you interested in applying for financial assistance?*

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
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Has the applicant ever been involved in a serious infraction of school rules that caused him or her to be suspended, withdrawn, or expelled from the school?*
Has the applicant had any history of excessive tardies or absences from school?*
Has the applicant ever received public or private services for an identified learning disability?*
Are there any medical diagnoses that could impact his or her success in a classroom environment?*
Has the applicant ever been arrested?*
Does the applicant have any history of health problems (physical or emotional)?*
Is the applicant on medication?*
Does the applicant have any type of learning disability, difficulty or limitations?*
Does the applicant have any type of learning modification or individual education plan (IEP) – past or present?*
Has any form of academic/executive functioning testing been done for the applicant in past years?*
Accepted file types: pdf, doc, docx, Max. file size: 300 MB.
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
Accepted file types: pdf, doc, docx, Max. file size: 300 MB.

Parent Information

Consent*
Consent*
Date
Date

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

Pastor or Youth Leader*
Academic Reference (teacher, principal, guidance counselor)*

132 Titus Ave
Manchester, NH 03103

(603) 606-7930

[email protected]

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