NORTHSIDE CHRISTIAN SCHOOL ADMISSIONS APPLICATION A COPY OF THE BIRTH CERTIFICATE, SOCIAL SECURITY CARD, IMMUNIZATION RECORD AND RECENT REPORT CARD (IF APPLICABLE) MUST ACCOMPANY THIS APPLICATION FORM. This application does not assure final enrollment but provides information upon which a decision will be based. Northside Christian School reserves the right to alter class selection based on final enrollment. A. N.C.S. NON-DISCRIMINATION POLICY: In the spirit of Christian unity and the love that Christ shows for all mankind, Northside Christian School does not discriminate on the basis of race, sex, or national origin. However, Northside Christian School does reserve the right to use appropriate selection criteria in fulfillment of its stated goals and objectives. B. GENERAL RECORD: Application for Grade Term 20-20 New Student Returning Student Year Last Attended Student Last Name First Name Middle Name Male Female Social Security # (Required) - - Age Date of Birth Home Ph. Address: P.O. Box # City State Postal/Zip Ethnic Category: African American American Indian/Alaskan Native Asian Caucasian Hispanic/Latino of any race Native Hawaiian or other Pacific Islander Two or more races Resides with (Check one): Mother/Father Mother Only Father Only Guardian Father/Stepmother Mother/Stepfather Doctor s Name Emergency Contact s Name Home Ph. Cell Title (Check one): Mr. & Mrs. Mrs. Ms. Mr. Dr. & Mrs. Rev. & Mrs. Name of Parent/Guardian First Name Last Name First Name Last Name Mother s Name Home Ph. Cell Email Employer s Name Father s Name Home Ph. Cell Email Employer s Name
Other School Age Children in Family: Name Age Grade School Name of person(s) authorized to pick up student: Relationship Were you ever denied admission to a school? Why? Were you ever suspended, expelled, or asked to withdraw from school? When? Why? Last school attended: Have you ever repeated a grade or grades? If so, please explain C. CHILD S SPIRITUAL RECORD: Home Church (Name) (Address) (Denomination) Church Now Attending Senior Pastor Youth Pastor Have you accepted Jesus Christ as your personal Lord and Savior? Year Have you received the baptism of the Holy Spirit with the evidence of speaking in other tongues? Yes Year If no, are you open to this experience? Yes No Have you been water baptized? Yes No Year Are parents an active member of Northside Assembly of God? Yes No Father: Christian? Yes No Mother: Christian? Yes No Do you attend one service per week at your church? Yes No No D. PARENTAL TERMS OF AGREEMENT: A) I commit myself to assume my spiritual responsibility to prayerfully and financially support the educational ministry of Northside Christian School. B) I understand that my child will be involved in various school activities both on and off campus, such as athletic and educational trips, and I absolve the church / school from my liability due to injury to me or my children at any such activities. C) I realize that the school has the right, after parental conference, to dismiss any child who fails to comply with the established discipline and rules of conduct. D) I agree to withdraw my child(ren) from N.C.S. should I fail to fulfill my financial obligation as outlined by school policy.
E. PARENT QUESTIONNAIRE: (Attach additional sheets if necessary) How did you find out about Northside Christian School? What do you see are your child s greatest needs? Spiritual: Behavioral: Academic: Social: How do you see yourself being involved in the educational process of your child? What do you see are the strengths of your child? Please explain below why you want your child to attend Northside Christian School: Please list any allergic reactions your child has had: If there are any physical problems or special instruction please comment:
F. STUDENT QUESTIONNAIRE (For Grades 7-12 Only) Have you used drugs, alcohol, tobacco, or been involved in improper sexual activity? Yes No If yes, please explain: What are your favorite subjects? Why do you feel you should be accepted as a student at Northside Christian School? If you are accepted as a student at Northside Christian School, what type of student would you be? What are some goals that you have for your life? AFFIRMATION: I hereby affirm that all the information contained in this application is true and accurate to the best of my knowledge. I understand that providing any false information would be sufficient reason for the rejection of this application. I further understand that I may be asked for additional written affirmation concerning such items as academic record and financial income. Student Date Father or Guardian Date The Signatures of BOTH PARENTS ARE REQUIRED unless you are a single parent! Mother Date Northside Christian School 809 E. Northern Ave. Crowley, La. 70526
Northside Christian School Elementary School Office 809 East Northern Avenue Crowley, LA 70526 : 337-783-3620 Fax: 337-788-3461 Training Mighty Warriors for Christ High School Office 811 East Northern Avenue Crowley, LA 70526 : 337-783-3649 Fax: 337-788-3461 Student s Name Grade Dear Pastor, The student listed above has applied for admission to Northside Christian School. Northside Christian School exists as an extension of the discipleship and training program of the student s home. It is necessary that we receive support and assistance from the home and local church to effectively minister to the student. Thank you for taking the time to answer the following questions concerning this student. Please complete the information below and return it to Northside Christian School. Thank you, Randy Trahan, Pastoral Administrator Is this family faithful in attendance to your local body of believers? How many Sunday services has the family attended in the last 6 months? Midweek services? Does this family express financial stewardship in the areas of tithing and paying bills? Is this family in harmony with the leadership of your church? Describe the spiritual commitment of the student: Can you recommend this young person as a student at Northside Christian School? Pastor s Signature Date Name of Church Address of Church A Ministry of Northside Assembly of God