Crossroads Christian Academy
Application for Admission
Section I – Student Information
Student Name ______________________________________________
Address ___________________________________________________
Telephone ____________(home) ______________(cell) _____________(work)
Email address _______________________
Birthdate ____________________ School Grade you are entering ____
Is student a Christian? _______ Church name_____________________
Pastor name and phone _______________________________________
Section II – Parent or Guardian information
Relation: (circle one) Father Step-Father Legal Guardian
Name ____________________________________________________
Address (if different from student) ______________________________
Telephone ____________(home) ______________(cell) ____________(work)
Email address _______________________
Are you a Christian? ______ Church name_______________________
Pastor name and phone ______________________________________
Work information: Company name/phone ________________________
Company address ___________________________________________
Type of work _______________________________________________
Relation: (circle one) Mother Step-Mother Legal Guardian
Name ____________________________________________________
Address (if different from student) ______________________________
Telephone ____________(home) ______________(cell) ____________(work)
Email address _______________________
Are you a Christian? ______ Church name_______________________
Pastor name and phone ______________________________________
Work information: Company name/phone ________________________
Company address ___________________________________________
Type of work _______________________________________________
Section III – Educational Information
On a separate sheet of paper, please provide the following facts about the students’ school history: 1) number of years and the grades student homeschooled, 2) the name, address and phone number of every school student has attended including the reason for leaving and 3) any special needs that the student may have including educational challenges, learning disabilities or physical disabilities.
Section IV – Spiritual Information
Parents: On a separate sheet of paper, please tell us about your relationship with Christ. If you are a Christian, please tell us how and when you gave your life to God. Please also tell us if you are in agreement with our vision statement (below) and why you think Crossroads is the right place for your child’s high school education.
Our Vision: Crossroads Christian Academy is a community of believers spurring one another on toward Christ, offering academic support to our families while retaining the parents’ God-given right and responsibility to educate their children. We are equipping students to walk into their God-given destinies.
Students: On a separate sheet of paper, please tell us about your relationship with Christ. If you are a Christian, please tell us how and when you gave your life to God. Please also tell us why you want to attend Crossroads.
________________________________
(Applicant’s Signature)
________________________________
(Parent or Guardian’s Signature)
________________________________
(Parent or Guardian’s Signature)
________________________________
(Date)
Academic Information from Primary Homeschool Instructor
Student Name: ________________ Entering Grade: ____ Form answered by _______________
Number of years and grades in which you homeschooled _______________________________
Note: This form is to help us gain understanding about your student’s academic and behavioral strengths and weaknesses. Please answer all questions candidly and honestly.
ACADEMICS:
Please fill out the following table:
|
Subject |
At or above grade level |
Learning is Easy/ Moderate/ Difficult
|
Please tell us 1) any strengths or weaknesses this student has in these subjects and/or 2) a specific curriculum that was successfully used in subject and/or 3) other pertinent information. |
|
Math |
Y / N |
E / M / D |
|
|
Science |
Y / N |
E / M / D |
|
|
Writing |
Y / N |
E / M / D |
|
|
Verbal Skills |
Y / N |
E / M / D |
|
|
Reading Comprehension |
Y / N |
E / M / D |
|
Is this student an independent learner? ______________________________________________
Is this student self-motivated? _____________________________________________________
Does this student work to his or her potential? ________________________________________
What are this student’s greatest academic strengths? __________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What are this student’s greatest academic weaknesses?________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Please tell us any other information that you think we should know about your student’s academic
performance: __________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
BEHAVIORAL:
What three words come to mind when thinking of this student? ___________________________
_____________________________________________________________________________
Please think of the authority figures that this student has in many different areas of his/her life. Please describe how student reacts to these people when corrected. Does student need frequent correction? ____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What is your student’s greatest strength? ____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
What is your student’s greatest weakness? __________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe your student’s relationships with his/her peers: _______________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe your student’s general demeanor and conduct: ________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe any recurring discipline issues with which your student struggles: _________________
_____________________________________________________________________________
_____________________________________________________________________________
Additional comments: ___________________________________________________________
_____________________________________________________________________________
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Please mail to: Crossroads Christian Academy, PO Box 3573. Littleton, CO 80161
