K5-12th Application - Apostolic Christian Academy

Interested in joining ACA?

Prior to registration, please click on the link “Schedule a Tour” located on the HOME page, or call the front office at 865-984-0046 to schedule an in-person meeting with administration.

Prerequisite for Admission to ACA

Birth Certificate
Immunization Record
Prior School Record (if applicable)
Social Security Card
New Student: Letter of Recommendation *Please send to admin@acamaryville.org*

These documents must be submitted to administration prior to the beginning of the school year.

Student Information

Student Name*

First Middle Last

Grade Level*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Cell Phone*

Birth Date*

Last school attended, if other than ACA

Parent Information

Father's Name*

First Last

Father's Email*

Father's Phone*

Father's Work Phone

Father's Employer*

Mother's Name*

First Last

Mother's Email*

Mother's Phone*

Mother's Work Phone

Mother's Employer*

Education Information

Has child failed?*

Does student have an I.E.P. (Individualized Education Program) issued from previous school?*

Please explain issued I.E.P.

Does student have a current 504 plan or any other plan recommending accommodations?*

If yes, please explain.

Is student in good standing and eligible to re-enter current school at the next grade level?*

If no, please explain.

Has student ever been suspended or expulsed from school?*

If yes, please explain.

What grade?*

Medical

List any physical difficulties including allergies:

Does student require medication that will be administered while at school?*

If yes, a medical authorization form is required to be completed prior to admission.

PRESCRIPTION MEDICATION AUTHORIZATION FORM

I have read, completed, and submitted Apostolic Christian Academy's Prescription Medication Authorization Form to Apostolic Christian Academy's front office.

Child's Physician*

Physician Phone Number*

Emergency Contact Information

Person to contact in case of emergency (other than parents):*

First	Last	Phone

Transportation Information

I authorize the following people to pick up my child:*

First	Last	Phone

Other Information

How did you hear about us?*

Please List

Church you now attend*

Reason(s) for selecting Apostolic Christian Academy:

Are you interested in financial aid assistance for tuition investment?*

Statement of Cooperation and Agreement

Consent

I have read and agree to Apostolic Christian Academy's Statement of Cooperation and Agreement

Parents/guardians of the student named above, has he/she ever been disciplined by any other school for the use of drugs or for promiscuous behavior?*

I understand that no student will be accepted by APOSTOLIC CHRISTIAN ACADEMY who has experimented with illegal drugs, or participated in occult activities. I understand any use/experiment of contraband drugs will result in immediate expulsion with no right to appeal. I understand that students of ACA are expected to keep high standards and to have high moral conduct. No student sexually active will be admitted to ACA. I further understand that any violation of this rule will result in expulsion.

What action was taken?*

Parent/Guardian Signature

Date*