1600 MLK Jr. Blvd. Dalton, GA (Fax)

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1 1600 MLK Jr. Blvd. Dalton, GA (Fax) Thank you for considering Christian Heritage School. Your prompt completion of the following steps will expedite the admissions process: 1. New Student Inquiry Form Complete and return the form, one per applicant, along with the non-refundable application fee of $50.00 per student. NOTE: Effective March 1, Applications will be accepted online and the application fee will increase to $75.00 per student. ADMISSIONS PROCESS a signed statement by a school official that student does not have a discipline report), and health documents (Certificate of Immunization Form 3231, and Eye, Ear, Dental Examination form). 2. Parent/Student Visitation 2012 Parent/Student Visitation Days are scheduled for February 22nd, March 14th and May 2nd. If you would like to schedule a separate school tour, please contact the admissions office at , ext School visits are not required for admission. 3. Application for Admission Read and complete one per applicant, following instructions as given. 4. Admissions Testing 1. The testing fee is $25.00 per student and is non-refundable. 2. All applicants for Kindergarten are required to have a K-Readiness assessment. The Kindergarten assessment for the school year is scheduled the last week in April. Please contact the guidance counselor, Nancy Plemons, at 3. For students applying for grades 1-3, the results of a nationally normed standardized test taken within the last 12 months will be accepted. If no such testing records are available, or if additional testing is necessary, a test date will be scheduled by school personnel. 4. Students applying for grades 4-12 are required to take a nationally normed admission test, and they are expected to score above grade level (55% or above in total math and total reading). Testing dates are February 24th & 25th, March 9th & 10th, April 18th & 19th, May 15th & 16th. Please contact the guidance counselor, Nancy Plemons, at to schedule testing. 5. Transcript / Authorization of Release of Educational Records Complete and sign the form and send it to the student s current school, requesting that the student s records be mailed to Christian Heritage School. Records required for admission include a transcript of grades, standardized test scores, copy of birth certificate, social security number, discipline report (or 6. Teacher Recommendation Form Send the form to the student s current school to be completed by the appropriate teacher(s). The completed forms should be mailed to Christian Heritage. 7. Pastor Questionnaire This form should be given to the applicant s pastor. The pastor should complete the form and mail it to Christian Heritage. 8. Sponsoring Family Form or Family Interview A final requirement before acceptance is a written recommendation from a CHS family or a family interview with a school administrator. This part of the process will be scheduled when all other required documentation has been received. Returning CHS families are required to participate in a Family Interview with one of the CHS School Administrators. 9. When all admissions requirements have been met, the applicant s file will be sent to the Admissions Committee for consideration. A decision regarding acceptance or denial will then be made, and an acceptance or denial letter will be mailed to the parents of the applicant. 10. An acceptance letter will include a Financial Agreement. For a student to be officially enrolled, the Financial Agreement must be signed and non-refundable enrollment fee paid, by the deadline specified in the acceptance letter. No guarantee of admission for the first day of the fall semester can be given when required documentation is received after the deadline. The parents signature on the Financial Agreement signifies that the parents and the student have read and agree to abide by the rules and policies in the Parent / Student Handbook. NOTE: Effective March 1, Enrollment processing will be completed online. 11. CHS offers only need-based financial aid. After acceptance, please request financial aid information by ing, Teri Ward, at

2 Student s Full Name ( ) Last First Middle Name Child Prefers Full Day Kindergarten 8:00 am - 2:45 pm Half Day Kindergarten 8:00 am - 12:00 pm Pre First 1st - 12th Age Applying for Grade To Enter In Boy Girl Month Year Check the Way in Which You Became Interested in Christian Heritage: Pastor Relative Advertisement Brochure on School Other Internet Friend STUDENT AND CONTACT DATA Social Security # Present Date of Birth (Required in order to process Hope Scholarship) Month Day Year Street City State County Zip Birthplace City State Home Phone Emergency Phone Dad s Cell Phone Dad s Mom s Cell Phone Mom s If a citizen of a country other than United States, will I-20 Immigration Form be needed? Yes No If student visa (I-20) is not needed, what form of visa will student use to enter the U.S.? Please list student s musical, artistic, dramatic, leadership, academic or other co-curricular activities. List sports in which the student is interested in participating. Important: If your student is in middle school or high school, please check the school calendar on our website or contact the athletic office for sport specific tryout dates. FAMILY DATA Father s Name Street City State/Country Zip Area Code & Telephone Occupation Business City State/Country Zip Area Code & Work Telephone

3 Mother s Name Street Occupation City State/Country Zip Area Code & Telephone Business Street City State/Country Zip Area Code & Work Telephone Please Star ( ) above which address to use for all correspondence about this application. Marital Status: Married Divorced Separated Widowed Please disclose any custodial arrangements that exist between divorced parents. Student resides with (please circle all that apply): Mother & Father Mother Father Guardian Stepfather Stepmother Father is Deceased Mother is Deceased Other: Please list chronologically all other children living with the family: Name Birthdate School Attending CHURCH AFFILIATION DATA Father (Guardian) Mother (Guardian) Church Attending Church Attending Member of above church? Yes No Member of above church? Yes No Pastor s Name Pastor s Name Church Church Church Telephone Church Telephone Student Church Attending Youth Pastor s Name Church Church Telephone Does the applicant attend regularly? Yes No Does the mother attend regularly? Yes No Does the father attend regularly? Yes No

4 Testimony of Personal Christian Experience and Faith: (Use a separate sheet of paper if needed.) Father Mother State briefly why you wish your child(ren) to attend Christian Heritage School. Is it your intention for the applicant to graduate from CHS? Why or why not? How do you anticipate that Christian Heritage School will help support what you are trying to achieve at home?

5 GUIDANCE AND ADMISSIONS DATA List current or last school attended School Phone Headmaster/Principal List Grades Attended List chronologically all other schools attended, beginning with kindergarten: DATES GRADE NAME OF SCHOOL Scholastic grades have been: Superior Above Average Average Below Average Please answer yes or no to the following questions: Has the student ever... skipped a grade? which grade? repeated a grade? which grade? received counseling due to a serious personal problem or event? been diagnosed as having a learning problem? had any medical condition which might impair his/her learning or academic ability? exhibited greater than average difficulty learning new concepts? PLEASE LIST ANY CURRENT MEDICAL CONDITIONS OR ALLERGIES. If you answered yes to any of the above items, please explain. Please include records of any assessments or have them forwarded to the Admissions Office. DISCIPLINE DATA Please answer yes or no to the following questions: Has the student ever... received a severe disciplinary censure at school? been suspended from school? been asked to withdraw from school? been expelled from school? used illegal drugs or abused legal narcotics or alcoholic beverages? been arrested or in trouble with law enforcement? If you answered yes to any of the above items, please explain. Please include documents related to all charges and/or convictions or have documents forwarded to the Admissions Office.

6 FOR COMPLETION BY STUDENT Please have the student use a separate sheet of paper and answer the following questions in his/her own words. Elementary Students (Grades K/5-5th only - parents may assist if needed) 1. What do you know about Jesus? 2. Why do you want to attend CHS? Middle School Students (Grades 6th - 8th) 1. Why do you want to attend CHS? 2. Describe your personal relationship with Jesus Christ. 3. Write a paragraph telling about yourself, your personal interests, and your interest in academics. High School Students (Grades 9th - 12th) 1. Describe your relationship with Jesus Christ. 2. How does your lifestyle show that you are a Christian? 3. Describe your personal strengths and weaknesses. 4. In your own words, state your response to the following areas as it relates to the Christian lifestyle: a. Entertainment (music, movies, TV, hangouts); b. Dress and Appearance; c. Attitude toward authority and discipline; d. Academic studies and extracurricular activities. 5. Briefly state the reasons why you desire to enroll in Christian Heritage School. REFERENCES Please list two people, other than current teachers, pastors, or relatives who know your child well. Name City, State, Zip Phone Name City, State, Zip Phone REQUIREMENTS FOR HOME-SCHOOLED STUDENTS Students entering Grades 2-9 must submit a record of grades and attendance preferably from a home-schooling agency. All students must include a record of Stanford Achievement Test scores, if available. If a record of standardized testing is not available, then students entering grades 2-11 must be tested according to the testing guidelines as described in #4 on the front of this application. Students entering Grades must have a transcript from an accredited home-schooling agency as well as any available Stanford Achievement Test scores from previous years. REQUIREMENTS FOR INTERNATIONAL STUDENTS Please complete all admissions paperwork and include a copy of the student s passport. Proof of immunizations and health/traveler s insurance for the United States is required. Please include a paragraph, written by the student, stating host families preferences as related to privacy, other children, pets, and any diet concerns. CURRENT TOEFL SCORES ARE NECESSARY IN ORDER TO PROCESS THE STUDENT S APPLICATION. Please see our website at chslions.com for current International Student Tuition and Host Family stipends. AGE REQUIREMENTS Kindergarten students must be five (5) years old before September 1st. First Grade students must be six (6) years old before September 1st. I understand that the grade placement of my child will be made upon the recommendation of the administration in consultation with the parents.

7 FAMILY COMMITMENT (Please Read Carefully) 1. We as parent(s) or guardian(s) accept God s responsibility which says, Fathers, do not exasperate your children; instead, bring them up in the knowledge and instruction of the Lord, (Eph. 6:4), and do affirm that this training is carried on in the home. We promise that the home will provide a secure haven of safety, free from influences we recognize as harmful. 2. We have carefully examined and agree with the Mission Statement and the Doctrinal Statement of Christian Heritage School as stated on the back page of this application, and we desire a partnership with CHS in the total education of our children. 3. In full cooperation with CHS, we will regularly attend the Parent-Teacher-Student Fellowship (PTSF) meetings and other functions requiring our participation. 4. We pledge our loyalty to the aims and ideals of CHS and promise to direct any criticism to the appropriate person as outlined in the grievance section found in the Parent/Student Handbook. 5. The teachers and administrators are given authority in the discipline of our children, within the discipline guidelines stated in the Parent/Student Handbook. This includes the right to corporal punishment in the Elementary School. 6. We agree to support the policies and procedures set forth in the Parent/Student Handbook. It is understood that these policies apply to student behavior both on and off campus as long as he or she is enrolled as a student at Christian Heritage. We understand and accept the fact that the Administration and Board of Directors have the responsibility and freedom to determine when it is in the student s and/or school s best interest for a student to withdraw. If this is determined in the case of our family, we will cooperate and support the decision to withdraw as quietly as possible, avoiding discussion with those not involved. 7. Students are accepted on a trial basis for the first grading period (9 weeks) to evaluate their academic and behavioral adjustment to CHS. 8. Christian Heritage agrees to work closely with the parents or guardians in helping the students learn to solve their school related problems. 9. We understand that Christian Heritage School is a non-profit ministry operating on the principle of faith. Tuition is kept as low as possible to make Christian education available to those who desire it for their children. Tuition and fees do not cover all operating costs. Additional funds and needs must be met with gifts from the parents, friends, grandparents, alumni, foundations and corporations. We ask that each parent purpose to give, as regularly as God provides, to meet the financial needs, to perform services when needed, and to uphold CHS consistently in prayer. 10. Tuition and fees will be based on the rates published on the Financial Information Sheet in effect for the applicable year. After acceptance, the submitted Application and Enrollment Fees are NON-REFUNDABLE under any circumstances, and do not apply toward tuition. We understand that this Family Commitment is also a binding financial obligation. While tuition is prorated on a monthly basis for students entering during the year, all other fees (application, testing, enrollment, etc.) are payable in full when a student first enters school. For students leaving during the school year, parents are required to pay for the entire semester in which their child(ren) are withdrawn. We have read the Family Commitment, the Mission Statement, and the Doctrinal Statement and are in agreement with each one. We understand this commitment will become binding upon enrollment. We understand that CHS requires all copies of the records and/or reports of current diagnoses to be forwarded to the Admissions Office. Withholding educational evaluations, psychological data, medical records, discipline records and/or any other required information may result in student s non-acceptance or dismissal. Signature Father Date Mother Date APPLICATION IS INCOMPLETE WITHOUT SIGNATURES

8 Our Mission Educating children from Christian families by developing within them the character, knowledge and skills necessary to serve Christ effectively in their day Doctrinal Statement A. The Bible The Holy Scripture is the only sufficient, certain and infallible rule of saving faith and obedience. The Bible is the inspired and inerrant Word of God. II Timothy 3:16; II Peter 1:20-21; Matthew 5:17-18; I Thessalonians 2:13; I Corinthians 14:37 B. The Trinity The God of the Bible is one in essence yet revealed in three Persons; the Father, the Son, and the Holy Spirit. These three Persons are the same in substance, equal in power and glory. God is our Creator, Ruler, Redeemer, and Judge. Matthew 28:19; II Corinthians 13:14 C. The Father First Person of the Trinity God, the Father, is the first Person of the Godhead. He is eternal, infinite Spirit and the Sovereign Ruler over all creation, both visible and invisible. Genesis 1:1; Exodus 3:14; Psalm 24:1; John 8:28-29; Ephesians 1:3-11 D. The Son Second Person of the Trinity Jesus Christ is the second Person of the Godhead, co-equal and co-eternal with the Father. He was conceived by the Holy Spirit, born of the Virgin Mary, lived a sinless life, died a substitutionary death and was raised bodily from the dead. He ascended into Heaven and is seated at the right hand of God the Father as King of kings and Lord of lords. Isaiah 7:14; Luke 1:34-35; John 10:29-33; Phillipians 2:6-7 E. The Holy Spirit The Third Person of the Trinity The Holy Spirit is the third Person of the Godhead, co-equal and co-eternal with the Father and the Son. The Holy Spirit is given to every believer at conversion as the Indwelling Comforter, Guide, and Helper. Genesis 1:1-2; John 14:16; John 15:26-27; John 16:7-11; Romans 8:9; Titus 3:5 F. The Fall Man was created in a state of sinlessness, but he voluntarily broke God s law, and both sin and death entered the world. As a result, every person lives under the bondage of sin and the threat of eternal separation from God. No one is able to save himself. Consequently, without saving faith in Jesus Christ, everyone is under condemnation. Genesis 3:1-3; Psalm 51:5; Romans 3:23; Romans 5:12; Ephesians 2:1; Hebrews 2:9; II Corinthians 5:21; I Timothy 2:5-6; Romans 3:21-26 G. Salvation Through His mercy and grace, God provided redemption in the work of Jesus Christ, who in His death took upon Himself the guilt and condemnation of His people and in His resurrection broke the power of sin and death. Only through His finished work can man be justified by faith, adopted into the family of God, and assured of eternal life. Hebrews 2:9; II Corinthians 5:21; I Timothy 2:5-6; Romans 3:21-26 H. Christian Life God s requirement for every believer is to live by loving God and consistently obeying His commands. John 14:21; John 15:5; I Peter 1:13-19; I John 2:4-6 I. The Gospel The Gospel is the Good News that Jesus Christ lived a sinless life, died an atoning death, and was raised bodily from the dead to redeem sinners from the guilt of sin and fear of death. This redemption causes the sinner to be born again. He trusts Jesus Christ alone for salvation, receives a new spiritual nature, and is assured of eternal life. I Corinthians 15:1-9; John 3:3; Romans 5:1-2; I Peter 3:18 J. The Church Jesus Christ has a body on this earth which is His Church. She is made up of His people. He is the Head of the Church and has commissioned her to make disciples from all nations. Matthew 16:18; Colossians 1:18; Ephesians 3:10; Matthew 28:19; Ephesians 4:4-16 K. Return of Christ Christ will personally return in glory to execute final judgment. The unrighteous will be condemned to endless punishment in Hell and the righteous will enter into endless joy in Heaven. John 14:3; I Thessalonians 4:13-18; Revelations 19:11-16

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