New Student Application Form

Student’s Last Name

Student’s First Name

Student’s Middle Name

Student’s Social Security Number

Home Address

City

State

ZIP Code

Phone

Date of Birth

Gender

Male

Female

Birthplace

Grade Entering

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

Freshman

Sophomore

Junior

Senior

Current Grade

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

Freshman

Sophomore

Junior

Senior

Father’s (or Male Guardian’s) Full Name

Occupation

Employer

Work Address

Work Phone

Cell Phone Number

Primary E-mail Address

Mother’s (or Female Guardian’s) Name

Occupation

Employer

Work Address

Work Phone

Cell Phone Number

Primary E-mail Address

Name of Emergency Contact (Other Than Parent)

Emergency Contact’s Phone Number

Family Status

Married

Divorced

Widowed

Remarried

Single Parent

If the child is not living with both parents, please explain with whom he lives.

Names of brothers and sisters attending North Valley Baptist Schools.

Church Affiliation

Do you attend church regularly?

Yes

No

Have the following been saved and baptized? Please check if yes.

Father (or Male Guardian)

Mother (or Female Guardian)

Student

Has the student ever been expelled?

Yes

No

Has the student ever been retained? If yes, please indicate below.

Never retained

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

Freshman

Sophomore

Junior

Senior

Last School Attended

Address

Grade Last Year

Passed

Passed on probation

Retained in grade

Has the student ever attended North Valley Baptist Schools?

Yes

No

If the student has had any academic difficulties in school thus far, please explain.

Condition of Health

Good

Fair

Poor

Physical Disabilities

If you answered ‘Physical Disabilities’ above, please explain.

Has the student ever had any incidents with the law, or does he have a police record?

Yes

No

If you answered ‘Yes’ above, please explain.

Is the student a United States citizen?

Yes

No

Please state the reasons why you wish for this student to attend North Valley Baptist Schools.

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