Secondary Student Survey

Student Name

Grade Applying For

In order to enroll a student at Central Arkansas Christian Schools, the parent(s) or legal guardian(s) and prospective student are required to complete this form, sign and return to the admissions office. This information will remain confidential.

Please explain any “Yes” answers on the bottom of this page.

1. Has the student ever been suspended or expelled from school or assigned to an alternative learning center or rehabilitation program?

Yes
No

2. Is the student currently ineligible to re-enroll in the school from which he/she is transferring?

Yes
No

3. If transferring from a private school, is the student’s account current?

Yes
No

4. Has the student ever been diagnosed as having Attention Deficit Disorder or any other learning issues?

Yes
No

5. Is the student now, or have they ever been in consultation with a counselor, diagnostician or doctor concerning emotional or behavioral problems?

Yes
No

6. Has the student ever been charged with the possession or use of illegal drugs or controlled substances?

Yes
No

7. Has the student ever been involved in, or been the victim of, gang or cult-related activities?

Yes
No

8. Has the student ever been accused of, or been involved in, the possession of a dangerous weapon(s)?

Yes
No

9. If applicable, has the student ever had his/her driver’s license suspended or revoked or been charged with Driving While Intoxicated, Driving Under Influence or Minor in Possession?

Yes
No

10. Has the student ever been arrested or convicted by any civil authorities, including juvenile courts?

Yes
No

11. Has the student ever been married or divorced or expecting a child?

Yes
No

Please explain any "Yes" answers here:

Please list student’s club, organization and co-curricular activities.

Please describe the primary reason for wishing to attend Central Arkansas Christian Schools.

I became aware of Central Arkansas Christian Schools through:*

Applicants Must Demonstrate:

· Composite “C” average in academic classes
· Proficiency on nationally-recognized and norm-referenced tests (i.e., near or above 50th percentile)
· Freedom from severe learning/behavioral problems
· Adherence to CAC’s minimum/maximum age requirement
· A strong desire to be a member of a Christian learning community

Christian Community

The main purpose of Central Arkansas Christian Schools is to train young people to lead fully-developed Christian lives. I understand that this application cannot be approved until admission requirements are met. The Admissions Committee will determine final acceptance of all prospective students. If this application is accepted, I agree to abide by and honor the principles and policies of Central Arkansas Christian Schools.

If accepted, we agree to the immediate dismissal of this student from school for any incorrect or omission of information on this form.

Student Name

Date

Parent/Guardian Signature

Date

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