Student's Name (required)

Student's Grade (required)

Date of Birth (required)

Parent's Name (required)

Daytime Contact Number (required)

Today's Date (required)

Your Email (required)

(For 1st-11th) What school is the child currently enrolled in?

List of previous schools (include name, address, dates attended)

Briefly state your reasons for desiring your child’s enrollment in Community Christian School:

Has your child ever received diagnostic testing for learning disability (including ADD/ADHD)?:

If yes, please explain – including diagnosis and treatment

Does your child require any special curricular or classroom modifications?

If yes, please explain:

(For 1st-11th) Has student failed any grades/subjects or was retained?

(For 1st-11th) Has student failed any grades/subjects or was retained?

If yes, please explain

(For 1st-11th) Has student been refused admittance, placed on academic or disciplinary probation, suspended or expelled from any school(s)?

If yes, please explain:

Has student ever been placed in a grade instead of being promoted?

What grade?

What church does your family attend?

Name & grade of sibling(s) not seeking enrollment at CCS:

Any other information that the school needs to know:

Would you like to be scheduled for a school tour?

What is the best time to call?