STUDENT APPLICATION. After April 15 prior to the academic year of enrollment.

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1 Application Deadlines Standard Application: Late Application: Part-time Students: STUDENT APPLICATION Application Fee Paid: Amount: Paid by: Check # Cash Birth Certificate Enclosed Certified copy On or Before April 15 prior to the academic year of enrollment. After April 15 prior to the academic year of enrollment. Students who apply after July 31 may not be able to attend classes until the second week of school or later. The application deadlines above apply. However, part-time students are considered for enrollment once full-time student enrollment is finished after July 31 when class openings and the schedule are known. Applicant s Legal Name: Grade/Year to Enter / Application Type: Full-time Student Part-time Student (Grades 7-12 only) If part-time, what classes do you wish to enroll (please list): Application Procedure 1. Thoroughly complete one application per student. 2. Attach a certified copy of the student s official birth certificate or we can photocopy the original for you. 3. Attach the student s current immunization record. 4. Attach the appropriate application fee. 5. Mail or deliver the application and attachments to the following address: Application Fee Standard Application: Late Application: Schaeffer Academy Attention: Jill Wirth, Administrator/Registrar 2700 Schaeffer Lane, NE Rochester, MN $175 per student, $350 maximum per family $350 per student, $700 maximum per family Application Fees are non-refundable and non-transferable. Kindergarten Age Requirement Students seeking admission to Kindergarten should be 5 years old by the September 1 of the academic year of enrollment. Schaeffer Academy will consider early entrance for students with 5 th birthdays between September 1 and 30 who also meet or exceed specific requirements established by Schaeffer Academy. If you are interested in early admission, please request and review Schaeffer Academy s Early Entrance Requirements Form. Acceptance and Enrollment The application document and fee enable the work necessary to determine whether a student is a good fit for Schaeffer Academy. When all of the admission materials (see Admission Requirements) have been received and reviewed, the student and parents will be scheduled for an interview with the headmaster. Following that interview, they will be notified of their acceptance status. Students who are accepted will be provided a link in ParentsWeb to complete online enrollment and pay the 10% tuition deposit (first of ten tuition payment installments). Once online enrollment is complete and the first month s tuition has been paid the student is officially enrolled.

2 Applicant Information Student's Legal Name Grade/Year to Enter / First Middle Last Nickname (if applicable): If applying for Kindergarten, please indicate which Kindergarten Program: Half-Day Kindergarten M-F All-Day Kindergarten M-F Present Address Street City Zip County Home Phone Age Sex How long have you lived at this address? If new to Rochester, where did you relocate from? of Birth / / *** Place of Birth Father's Name Occupation/Field Employer Address: Mother's Name Occupation/Field Employer Address: Cell Phone Position: Work Phone Cell Phone Position: Work Phone Mailing information Please indicate below the parent(s) or guardian(s) with whom the business or educational officials of the school should communicate with in relation to this enrollment. Name Relationship Telephone Street City State Zip Student Lives With (circle one): Mother and Father Mother Only Father Only Legal Guardian Other Mother and Stepfather Father and Stepmother Grandparent(s) Please Note: It is the parent s responsibility to provide and keep up-to-date with the Office Administrator and Headmaster, the most recent court order addressing custody, access to student, parent rights to school information and decision regarding the education of the child. Academic Information List chronologically all schools your child has attended (include nursery and kindergarten): Name Address s Grades Is your child in good standing at current school? Yes No If not explain:

3 Would they be eligible for re-admission? Yes No If yes, are there conditions? If no, explain: List what problems your child has, if any (learning, behavior, discipline, health, physical, etc.) and explain: Does your child have a diagnosed disability? Yes No If yes, describe? Does your child have an IEP (Individual Education Plan), 504 Plan or accommodation plan? If yes, what plan and summarize? Has the child repeated any grades? Explain Has the child ever been dismissed or suspended at any school? If yes, explain: Any physical disability? Yes No Nature Has the student's hearing been checked? Vision checked? Does the student have any allergies? When? When? If so, describe Does the student take medication regularly? If so, describe Student's Physician Telephone What methods of discipline have you found to be effective? What special interests, skills, and abilities does your child have?

4 Is there any other information, which would be beneficial to us in further understanding your child? List name, birthdate, and school attending of all other children in the family: Name Birthdate (MM/DD/Year Grade (if applicable) School (if applicable) Does your family attend a church? Yes No Name of Church Church's Address Are you members? Street City, State Zip Pastor's Name Why do you wish to enroll your student in Schaeffer Academy? What are your educational plans at Schaeffer Academy for your child? (Check all that apply) Elementary (to 5 th or 6 th circle one ) Middle School (grades 7-8) High School (grades 9-12) Other: (explain): How did you find out about Schaeffer Academy? Nondiscriminatory Policy Schaeffer Academy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs. The information in the following section is used to comply with government reporting requirements: Home Language: Ethnic/Race: 1 st language learned by student: 1. Indian Language normally used: 2. Asian by student at home: 3. Hispanic by parents at home: 4. Black by student with friends: 5. White 6. Other:

5 U. S Residency and Status Information: Yes No United States Citizen Yes No Alien Resident Yes No Non-Resident Alien If Alien Resident or Non-Resident Alien, please complete the information below: entered the United States? From which country? Purpose of Entry? Type of Visa: Visa Expiration : STATEMENT OF PURPOSE The primary purpose of Schaeffer Academy is to operate a school to provide a Christ-centered and classical education that emphasizes academic excellence in liberal arts. Schaeffer Academy will closely adhere to the Statement of Faith and Statement of Purpose. The philosophy and content of education at Schaeffer Academy are founded upon the principle that it is necessary to remain faithful and obedient to the truth of God as revealed in the Scriptures. Schaeffer Academy attempts to operate as an extension of the family, recognizing the God-given responsibility and authority of parents to educate their children. At all its levels, programs and teachings, Schaeffer Academy seeks to: 1) Teach all subjects as parts of an integrated whole with the Scripture at the center (II Timothy 3:16-17); 2) Provide a clear model of Biblical Christian life through its staff and Board of Directors (Matthew 22:37-40); 3) Encourage every child to begin and develop his relationship with God the Father through Jesus Christ (Matthew 28:18-20); 4) Emphasize grammar, logic, and rhetoric in all subjects; 5) Encourage every student to develop a love for learning and to achieve his academic potential; and 6) Provide an orderly atmosphere conducive to attaining these goals. Agreement with this Statement of Purpose is necessary in order for your child to enroll in Schaeffer Academy. Please indicate your agreement by signing below. I/We have read the Statement of Purpose above and agree hereto:

6 STATEMENT OF FAITH 1. We believe the Bible to be the only inspired, inerrant, infallible, authoritative Word of God; inerrant in the original manuscripts. We believe the inerrancy of Scripture embraces not only religious truth, but also the Bible's scientific, historical, and literary features. 2. We believe that there is one God, eternally existent in three Persons: Father, Son, and Holy Spirit. 3. We believe that creation was an act of God, and that the creation of man was a specific act of God, so that man did not evolve from other species. 4. We believe in the deity of our Lord Jesus Christ; in His virgin birth; in His sinless life; in His miracles; in His vicarious and atoning death through His shed blood; in His bodily resurrection; in His ascension to the right hand of the Father; and in His future personal return in power and glory. 5. We believe that people are born with a sinful nature, and are in need of Jesus Christ as their personal Savior. 6. We believe in the Holy Spirit who came forth from God to convict the world of guilt in regard to sin and righteousness and judgment; to regenerate, sanctify, comfort, indwell, and enable the Christian to live a godly life. 7. We believe that salvation is by grace through faith alone in Jesus Christ alone as Lord and Savior and not as a result of works. Faith, which leads to salvation, will also be evidenced by good works. Therefore, we believe that those who repent of sin and receive by faith the Lord Jesus Christ are born again and shall be saved. 8. We believe in the resurrection of both the saved and the lost; they that are saved to the resurrection of life and they that are lost to the resurrection of damnation. 9. We believe in the spiritual unity of all believers in our Lord Jesus Christ. Agreement with this Statement of Faith is not necessary to enroll your child in Schaeffer Academy. However, those who sign below indicating approval of and belief in the Statement of Faith and who pay tuition to the corporation may be made a member thereof and have voting privileges. Choosing not to sign will exclude you from membership and voting privileges. I willingly endorse and subscribe to the above Statement of Faith as found in the By-Laws of Schaeffer Academy My signature indicates my affirmation of the following: The information I have provided is completely true. I/We hereby make application for student, to enter grade at Schaeffer Academy. (rev031814)