DATE___________________

ENROLLMENT DATE_____________________

STUDENT INFORMATION

NAME_____________________________________________________________ENTERING GRADE_________________
                                                         LAST   FIRST     M.I.

SOCIAL SECURITY #____________-_________-____________      NICKNAME (if used)___________________________

HOME ADDRESS_______________________________________________________________________________________
                                                                               NUMBER STREET APT.  CITY  ZIP CODE

PHONE# ____________________________________    MESSAGE  PHONE #_____________________________________

AGE_______________       BIRTHDATE_________/_________/__________         MALE_________     FEMALE_________

LAST SCHOOL ATTENDED_____________________________________________________________________________

ADDRESS______________________________________________________________________________________________

DATE OF WITHDRAWAL_______________________________REASON FOR WITHDRAWAL____________________

_______________________________________________________________________________________________________

REFERRED TO GOCS BY______________________________________________________________

FAMILY INFORMATION

FATHER’S  NAME____________________________________________________ SS#__________-_________-__________
       LAST  FIRST   M.I.

OCCUPATION          HOW LONG?_________________________

EMPLOYER_____________________________________________________  PHONE#_____________________________

ADDRESS______________________________________________________________________________________________
  NUMBER STREET APT.  CITY   ZIP CODE

NATIVE LANGUAGE____________________________________________________________

IF NOT ENGLISH HOW WELL DO YOU UNDERSTAND:

                                            EXCELLENT       GOOD               FAIR                POOR
CONVERSATION   ______________  _________ ___________ _____________
WRITTEN    ______________  _________ ___________ _____________
 
 

FAMILY INFORMATION cont.

MOTHER’S NAME______________________________________________________ SS#_________-________-_________

OCCUPATION          HOW LONG?_________________________

EMPLOYER_____________________________________________________  PHONE#_____________________________

ADDRESS______________________________________________________________________________________________
                                                                                  NUMBER STREET APT.  CITY   ZIP CODE
 

NATIVE LANGUAGE____________________________________________________________

IF NOT ENGLISH HOW WELL DO YOU UNDERSTAND:
                                          EXCELLENT           GOOD         FAIR                    POOR
CONVERSATION   ______________  _________ ___________ _____________
WRITTEN    ______________  _________ ___________ _____________

DO YOU REQUIRE A TRANSLATOR FOR CLEAR COMMUNICATION REGARDING SCHOOL MATTERS?

  MOTHER_________________  FATHER__________________

STUDENT LIVES WITH:  MOTHER _______ STEPMOTHER  ________
FATHER    _______ STEPFATHER   ________ OTHER________

PARENTS ARE:      MARRIED AND LIVING TOGETHER __________
         SEPARATED    __________
         DIVORCED     __________
         FATHER DECEASED   __________
         MOTHER DECEASED   __________

CHILDREN IN FAMILY OTHER THAN APPLICANT:

NAME___________________________________________________  AGE______________

NAME___________________________________________________  AGE______________

NAME___________________________________________________  AGE______________

DO YOU REGULARLY ATTEND: CHURCH  SUNDAY SCHOOL, TRAINING or BIBLE CLASS

FATHER    _________  _________
MOTHER    _________  _________
APPLICANT    _________  _________

HAVE YOU MADE A COMMITMENT TO JESUS CHRIST AS YOUR LORD AND SAVIOR?

FATHER____________  MOTHER_____________ APPLICANT_____________

CHURCH YOU PRESENTLY ATTEND____________________________________________________________________

ADDRESS______________________________________________________PASTOR________________________________

EMERGENCY INFORMATION

FAMILY PHYSICIAN_______________________________________________ PHONE#____________________________

ADDRESS______________________________________________________________________________________________
                                                                                         NUMBER STREET   CITY  ZIP CODE

EMERGENCY INFORMATION cont.

DOES APPLICANT HAVE ANY PHYSICAL OR MENTAL HANDICAPS?_____________________________________

IF YES, PLEASE DESCRIBE_____________________________________________________________________________
 
 

RESPONSIBLE PERSON TO CONTACT IF PARENTS CANNOT BE REACHED:

NAME____________________________________________ RELATIONSHIP____________________

HOME PHONE#____________________________WORK PHONE#____________________________

SCHOLASTIC INFORMATION

DOES THE APPLICANT HAVE ANY LEARNING, EMOTIONAL OR BEHAVIORAL PROBLEMS OR

DISABILITIES?_____________  IF YES, PLEASE EXPLAIN__________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

HAS THE APPLICANT EVER HAD ANY SERIOUS DISCIPLINE PROBLEMS IN SCHOOL?____________________

IF YES, PLEASE EXPLAIN______________________________________________________________________________

_______________________________________________________________________________________________________

HAS THE APPLICANT EVER FAILED A GRADE?__________________  IF YES, WHY?_________________________

_______________________________________________________________________________________________________

LAST YEAR THE  APPLICANT’S WORK WAS:

EXCELLENT_____________ GOOD______________  FAIR_______________                POOR___________
 

STUDENT PROFILE

HAS THE STUDENT EVER HAD:  TUTORING________________ SUBJECT(S)_________________________________

PSYCHOLOGICAL EVALUATION_____________________ COUNSELING ____________________________
REMEDIAL PROGRAMS______________________________ SPEECH THERAPY _______________________
VISION THERAPY____________________________________ PHYSICAL THERAPY_____________________

BRIEFLY DESCRIBE THE APPLICANT’S PERSONALITY, INTERESTS, AND ABILITIES_____________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

WHY DO YOU WISH TO SEND YOUR CHILD TO GOCS?__________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

HIGH SCHOOL APPLICANTS

GRADES  ENGLISH  MATH  HISTORY        SCIENCE  PE
7TH    _________  _______ _ __________        ___________ _________
8TH    _________  ________ __________        ___________ _________

DO YOU FEEL YOUR  JR. HIGH WORK HAS BEEN:  (CIRCLE ONE)

BELOW GRADE LEVEL  AT GRADE LEVEL  ABOVE GRADE LEVEL

WHICH ACADEMIC TRACK DO YOU PLAN?  COLLEGE PREP__________ GENERAL__________
 

REFERENCES:

TEACHER_____________________________________________________________________________________________
                                                                                                  NAME     ADDRESS    PHONE#

ADULT FRIEND________________________________________________________________________________________
                                                                                                  NAME    ADDRESS    PHONE#
 
 
 

STATEMENT OF COOPERATION

I hereby verify the above information to be accurate, complete and truthful.
I absolve the school from any and all liability to me, or my child, due to injury or accident at school or during any school activity.
I give permission for my child to take part in all school activities, including sports and school-sponsored trips away from the premises.  I understand that school policy states, that no refunds will be made on registration fees, book fees, or tuition for any month in which my child has attended school.
I agree to uphold any discipline deemed necessary by the teacher or the administration.  I understand that respect and obedience will be expected of my child and that corporal punishment may result for serious disobedience or disrespect.  I understand that it is essential to the proper functioning of the school that all fee and tuition payments be made on time
Since the fees do not cover the actual cost of educating our children, I recognize that my participation is needed in training.  I agree to attend parents and teachers for Jesus meetings as often as possible and to offer help, service, and support for all school fundraising activities.
I understand that all students are accepted on a six-week trial basis.

I have completed this application and read the statement of cooperation and do hereby request Gospel Outreach Christian School to process this application for acceptance.
 

__________________________________________________________  _______________________________
  PARENT’S SIGNATURE                                                                                           DATE
 

You shall love the Lord your God with all your heart, and with all your soul, and with all your mind.  Matthew 22:37