GATEWAY CHRISTIAN ACADEMY P.O. BOX 246 BETHEL SPRINGS, TN 38315

PLEASE FILL OUT EACH ANSWER. WE NEED ALL THE INFORMATION WE ASK FOR. THANK YOU!

STUDENT INFORMATION:

School Term/Year_______________Date______________ Cell Ph# ______________________

Full Name____________________________________________________________________

Address__________________________________________Home Ph#(       )__________________

City________________________________________State_____________Zip______________

County_____________ Age_______ Birthdate________________ Sex ________ Race _________ 

S.S. # _____________________ (Student)Driver's Lic. # ___________________________

School Last Attended______________________________________ County ______________ 

Ph# __________________________ Fax# _________________________

School's Complete Address ___________________________________________________________

_________________________________________________________________________________

Last Grade Completed_______ Current Grade Level _______ Withdrawl Form Included: ________

Board of Education Ph# ____________________________Fax# __________________________

PARENT/LEGAL GUARDIAN INFORMATION:

Father's Full Name_________________________________ Cell Ph# ____________________

Employment________________________________ Diploma/G.E.D ____________________

S.S. #_____________________________Business Phone___________________________

Mother's Full Name_____________________________________ Cell Ph#_____________________

Employment_________________________________ Diploma/G.E.D. _______________________

S.S. #_______________________Business Phone___________________________

Contact Ph# _________________________ 2nd Ph# _________________________________

SCHOLASTIC INFORMATION:

Has Student ever been expelled, suspended, or refused admission to another school?_____

If yes, explain in detail:___________________________________________________________

____________________________________________________________________________

Has student ever had disciplinary reports at school?_________

If yes, explain:___________________________________________________________

Does student have a juvenile or arrest record?____________

If yes, explain___________________________________________________________

Has student ever used/brought to school any tobacco or nonprescription drugs of any kind?____

If yes, explain:___________________________________________________________

Please indicate academic level of student's previous work:

Excellent_________Good___________Average_________Poor___________

Has student ever failed an academic subject in school?__________

If yes, explain:___________________________________________________________

Is student currently in any advanced or lower level classes? _____ If yes, explain___________

______________________________________________________________________________  

Report Card or Transcript Included: _________ If No, Explain? _____________________________

GENERAL INFORMATION:

How did you hear about this school?__________________________________________

Reason for selecting this school?_____________________________________________

Do you know someone interested in our Adult Education Class to obtain a High School Diploma?

____ If yes, Name:_______________________ Ph#____________________ Last grade:______

FEE'S:

Registration Fee: $50.00 amount paid today _________________

1st Tuition Fee: $80.00 amount paid today __________________

Answer Key Fee: $60.00 amount paid today ________________  Total Fee's paid today:_____________

Fee's must accompany application forms and are non-refundable.

Application must be filled out completely & should include a recent photo of student before it can be processed.

If child is in High School you must include a High School Transcript with Applications.

PLEASE FILL IN CONTRACT AGREEMENT OF YOUR CHOICE:

 I _______________________________ do hereby agree to Homeschool with Gateway Christian Academy for 10 months at the monthly tuition rate of $80.00 I also agree to monitor my child's academics for the state minimum of 4 hrs each day 5 days a week. I promise to see that my child completes Academic work that is required and takes tests for each subject in a timely manner by Gateway Christian Academy's rules. I agree and promise that I will ask permission from Gateway Christian Academy before I withdraw my child from the Homeschool program and pay all accounts owed, plus an early termination fee. All fee's are non-refundable once received at student's Registration. I also agree to purchase resource books or materials as needed for my child through out the school year. 

I _______________________________ do hereby agree to Homeschool my child with Gateway Christian Academy for the school year _____________ and I promise to monitor my child's academics and  testing schedule according to the state minimum of four hours daily for five days a week.  I am paying for my child's Booklets-Tests-Answer Booklets and any other materials or resource books needed for this school year in full and in advance. I am hereby obligated to monitor my child's academics and report testing scores to the Academy each 9 weeks. If needed Gateway Christian Academy will notify me of any further materials required.

Father/Legal Guardian _________________________________________________

Mother/Legal Guardian ________________________________________________