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Application for Admission and Instructions
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Application For Admission To Seventh-day Adventist church schools
 
A. STUDENT INFORMATION
Name:
Date of birth:
Age:
SSN:
Student Lives with: o Mother   o Father o Guardian (*If there is a legal/custodial guardian give name and relationship below.
Name ________________________________________________________   Relationship ______________________________________________
Check if appropriate:              o Father deceased                o Mother deceased                o Parents separated
                                            o Father remarried                o Mother remarried               o Parents divorced
If there are any court orders please attach and specify:
Are you a current member of the Seventh-day Adventist church?        o Yes      o No
*If yes, please specify current membership.
Name ______________________________________________ Location _______________________________________
Date Baptized in SDA Church ___________________  Denomination (If other than SDA) _________________
Grade Entering:
Gender:      o Male o Female
Place of Birth:
Language spoken at Home other than English:
 
Previous School Attended:
 
 
Ethnic Origin: (optional)
 
 
B. SIBLING INFORMATION 
List below all brothers and sisters, their ages, and the school they attend.
Name:
Age:                        Grade:
School:
Name:
Age:                        Grade:
School:
Name:
Age:                        Grade:
School:
C. PARENT/GUARDIAN INFORMATION
 
 
 
Father
Mother
Step-Father
Step-Mother
Name:
 
 
 
 
 
 
Home Address:
 
 
 
 
 
City / State / Zip:
 
 
 
 
 
Home Phone:
 
 
 
 
 
Cell Phone:
 
 
 
 
 
E-mail:
 
 
 
 
 
Occupation:
 
 
 
 
 
Employer:
 
 
 
 
 
Employer Address:
 
 
 
 
 
Work Phone:
 
 
 
 
 
Nationality (optional)
 
 
 
 
 
Church Membership:
 
 
 
 
 
 
 
 
 
 
 
 
 
D. EMERGENCY INFORMATION
 
 
Doctor’s Name _________________________________________________ Phone __________________
 
Address _________________________________________________________________________________________
 
 
Name of Neighbor or Relative ________________________________________ Phone ______________
 
Address _________________________________________________________________________________________
 
Name of Neighbor or Relative _________________________________________ Phone _____________
 
Address __________________________________________________________________________________________
 
If your child becomes ill at school, we will contact you to pick up your child. It is your responsibility, at this point, to either come to school or make other necessary arrangements for the pick-up of your child. If you cannot be reached, the office will begin calling the listed emergency contact persons. Please keep all emergency numbers and instructions CURRENT!     
 
 
No care beyond basic first aid may be given by school personnel. Should a medical emergency arise, the local area paramedics will be contacted. This action could involve your child being transported by ambulance to the nearest hospital. The parent will be financially responsible for the ambulance and any emergency room procedures.  
 
 
Present health insurance carrier ________________________________________________________________________
 
Policy Number ____________________________________ Phone ________________________
 
Name of the policy holder ______________________________________________________________________________
 
 
I have read and understand the emergency policy and agree to it.
 
 
Signature of Father/Mother/Guardian

___________________________________________________________________  
 
 
 
E. PARENT/GUARDIAN personal information
A. In order of priority, please list and explain three (3) reasons why you are seeking admission for your child(ren) to attend this Seventh-day Adventist Christian School:
 
1)
 
 
 
2)
 
 
3)
 
 
 
B. Parents, please respond to the following, giving us an idea of how you view your child. Check the applicable boxes using #4 as the strongest and #1 as the weakest.
 
QUALITIES
1
2
3
4
 
OBEDIENCE: responds willingly and immediately to wishes of authority
 
 
 
 
 
 
RESPECTFULNESS: shows esteem and honor for God, others, self and toward property
 
 
 
 
 
 
SELF-CONTROL: keeps hands to self; controls talking, emotions and behavior
 
 
 
 
 
 
RELIABLE: is trustworthy and dependable in word and deed
 
 
 
 
 
 
COURTEOUS: is polite, kind, considerate, gracious, patient, forgives, shares
 
 
 
 
 
 
ATTENTIVENESS: pays careful attention; listens fully
 
 
 
 
 
 
DILIGENCE: has steady energetic effort; makes good use of time; completes tasks and gets work in on time
 
 
 
 
 
 
NEATNESS: is clean, organizes and cares for personal possessions, work and appearance
 
 
 
 
 
  
C.
What do you see as your child’s academic strengths?
 
 
What do you see as your child’s academic weakness?
 
 
Has your child ever been recommended for testing, tested and/or diagnosed for any of the following? Check all that apply. If any are checked, please explain the situation below giving specific information.
 
                         o Attention Deficit Disorder           o Speech/language impairment
                         o Dyslexic                                   o Hearing impairment
                         o Hyperactivity                            o Visual impairment
                         o Learning Disability                     o Other _________________________________
 
Explanation of the above condition(s):
 
 
 
D.
Has your child been suspended or dismissed from any school? o Yes   o No If yes, please explain.
 
 
 
 
F. STUDENT TESTIMONY
(K-3 Optional, 4-12 Mandatory)
A.   Do you have a personal relationship with Jesus Christ?   o Yes    o No    o Don’t Know
 
Explain your relationship with Jesus Christ and how it influences the decisions you make and the relationships you have.
 
 
 
 
 
 
B.   Why do you desire to leave your present school?   
 
 
 
C.   List any activities in which you have participated or any awards received: 
 
 
 
 
D.   List any community involvement.       
 
 
 
 
G. AGREEMENT
 
I agree to see that this student’s tuition is cared for monthly.
 
I certify that I do not have any outstanding accounts at any other Adventist educational institution. (If you do, please specify where _____________________________________________________________________________________________.)
 
I agree to cooperate with the school board and teachers by avoiding adverse criticism of any teacher or school policies in the presence of students.
 
I have read the school policy book and agree to support each regulation of the school, written and oral.
 
I hereby authorize the school to send, upon request, the permanent records to the next school to which my child may enroll.
 
 
Signature of Parent or Guardian: __________________________________________ Date _____________
 
  
 
 
 
FOR OFFICE USE ONLY
 
Interviewed by: ___________________________________________________ Date ________________
 
Admission Committee: ______________________________________________ Date _______________
 
 
¨                    Approved Admission                                Check Items Received:
                                                                     ¨       Two Letters of Recommendation
¨             Denied Admission                            ¨       Cumulative Folder
                                                                     ¨       Current Immunization History
¨             Provisional Admission                       ¨        Birth Certificate Copy
                                                                     ¨        Social Security Card Copy
¨             Probationary Admission
                                                                                                                                                                                                                               
_____________________________________________________________________________________________ 
 
_____________________________________________________________________________________________
 
_____________________________________________________________________________________________ 
 
 
Illinois Conference
 
APPLICATION INSTRUCTIONS
 
Please type or print in ink all portions that apply to you.  For any item which does not apply to you write, “Does not apply,” or “None.” All address and phone number fields should be complete. Falsification or misrepresentation of information on the application may lead to dismissal from our school.
 
APPLICATION PROCEDURE:
 
Section A. Student Information
 
All information asked in this section pertains to the Pupil requesting admission.
 
 
Section B. Sibling Information
 
The full name (first and last name) is requested only if different from the student applying, otherwise first name would be sufficient.
 
 
Section C. Parent / Guardian Information 
 
Please make sure the information is legible and the information is applied to the correct column.  If you have more than one child and the parent / guardian information is identical you only need to complete this section for one child.
 
Section D. Emergency Information 
 
All sections need to be completed and signed.  Unsigned applications cannot be processed
 
Section E. Parent / Guardian Personal Information    
 
Parents / Guardian please fill out this section as thoroughly as possible, since this information will help us better understand your child and help them get the best academic experience.
 
Section F. Student Testimony  
 
Please think about each question and answer the questions as thoroughly as possible. 
 
Section G. Agreement  
 
All sections need to be completed and signed. Unsigned applications cannot be processed
 
Two letters of Recommendation
Two letters of recommendation have been included in this packet.
Make sure pupils name is printed on the first line, before handing it to the evaluator.
Example of individuals to ask: Teacher, Counselor, Pastor, Principal, Pathfinder/Scout Director/Deputy Director, Sabbath/Sunday School Teacher, someone that knows the pupil.
Recommendation letters should be returned to the applicant in a sealed envelop with the evaluators signature across the seal. These letters must be included by the applicant in their packet of application materials..     
 NOTE: All pupils entering this school for the first time MUST furnish:
 
1-        A completed application form.
 
2-        A copy of his/her birth certificate.
 
3-        A copy of his/her Social Security Card.
 
4-        A current record of up-to-date immunizations, as required by the state of Illinois.
 
5-        At least two recommendation forms.
 
Students who fail to comply with the above requirements may be denied admission or not be allowed to attend class. 
 
Illinois Conference of Seventh-day Adventists
 
STUDENT RECOMMENDATION FORM
Give this form to a teacher, pastor, or counselor who knows you well.
 
The confidential recommendation is for: _______________________________________________________
 How well do you know this student?   o Well   o Some   o Little   o Records only       
 How many years have you known this individual? _____________________

Please check the adjectives that most nearly describe the applicant’s standing in the areas listed below:
Trustworthiness                                        Loyalty to Leadership                                     Cooperation
o Very trustworthy                                  o Loyal and dependable                                o Helpful
o Generally trustworthy                          o Satisfactory                                                 o Works well with others
o Tends to be dishonest                         o Disloyal                                                        o Critical
 
Choices of Associates                             Church Attendance                                         Health
o Chooses wisely                                   o Attends regularly                                        o Very strong and healthy
o Somewhat wisely                                o Satisfactory                                                 o Average health
o Somewhat carelessly                         o Never attends                                              o Weak, low vitality
o Chooses carelessly                                                   
 
Work Habits                                              Intellectual Aptitude                                       Character & Integrity
o Resourceful and enthusiastic            o Very quick to learn                                    o Firm, steady, consistent
o Average worker                                   o Learns easily                                             o Fairly stable
o Works only under pressure               o Must study hard to learn                          o Weak, easily influenced
o Not interested in work                        o Educational disabilities
 
Christian Experience                               Personal Appearance                                    Financial Responsibility
 o Active                                                  o Well groomed                                           o Meets obligations promptly
 o Passive                                               o Neat and clean                                         o Usually meets obligations
 o Disinterested                                      o Careless                                                   o Does not meet obligations
 o Antagonistic                                       o No information                                                                                                                                                                                                                             
 
 Do you recommend the applicant as a desirable student for the Illinois Conference of Seventh-day Adventist school system?
 o With no reservation            o With reservation                                 o Cannot recommend
 
What is your relation to the applicant? ____________________________________________________________________________
 
Has the applicant within the last year used tobacco? Drugs? Alcoholic beverages? o Yes   o No
 
Explain: ____________________________________________________________________________________________________
 ___________________________________________________________________________________________________________
 ___________________________________________________________________________________________________________
  
Has the applicant, to your knowledge, ever been suspended or asked to withdraw from school? o Yes   o No
What school? _______________________________________________________________________________________________
 
Would you feel comfortable with this individual rooming with your son or daughter? o Yes o No

Your name (please print): ___________________________________________________ Position: __________________________  
Signature: _______________________________________ Date: __________________ Phone: ____________________________
 
Remarks: ___________________________________________________________________________________________________ 
 ___________________________________________________________________________________________________________
 ___________________________________________________________________________________________________________
 ___________________________________________________________________________________________________________
 
 
NOTE TO THE EVALUATOR: Recommendation letter should be returned to the applicant in a sealed envelope with the evaluators signature across the seal.