APPLICATION FORM
Student Information

Date

New Student

Re-enrollment

Social Security Number

Name (Last, First, Middle)
Address
City, State, Zip Code		County
Years of Home Schooling		Grade   Home Phone
Gender:	Male Female	Date of Birth      Race
Has student ever been suspended from school? Yes    No
If "yes," why?
Has student ever been arrested or held for questioning within the last two (2) years? Yes    No
If "yes," why?

Parent Information

Father's Name (Last, First)
Place of Employment
Work Phone	Drivers License
Mother's Name (Last, First)
Place of Employment
Work Phone	Drivers License

If the primary home schooling parent works outside the home, please fill-out this section. How many hours does the primary homeschooling parent work per day? While you're at work, who is in charge of teaching your child(ren)?

Which Church do you currently attend?
Will you assist in proctoring for SAT tests in spring at CVA? Yes No
How did you hear about CVA?
Parent/Legal Guardian Signature: _______________________________ Date ______________