Academic Year: _______________  Grade Entering: __________

Student Name: ________________________________________________________  Male _____  Female _____

Date of Birth: ___________  Place of Birth: ________________________________  Citizenship ____________

Home Address: ____________________________________________________________________________________

Home Telephone: ____________________  E-mail Address: __________________________________________

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Mother's Name: __________________________________________________  (check if legal guardian ______)

Address
(if different): __________________________________________________________________________________

Home Telephone (if different): ____________________________

Employer: _____________________________________________  Work Telephone: _____________________

Address: ____________________________________________________________________________________

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Father's Name: ___________________________________________________  (check if legal guardian ______)

Address
(if different): ________________________________________________________________________________

Home Telephone (if different): ____________________________

Employer: _____________________________________________  Work Telephone: _____________________

Address: ____________________________________________________________________________________

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List all siblings below:

Name: ____________________________________  Age: _______  Relationship: ________________________

Name: ____________________________________  Age: _______  Relationship: ________________________

Name: ____________________________________  Age: _______  Relationship: ________________________

Name: ____________________________________  Age: _______  Relationship: ________________________

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Name of church or fellowship you are currently attending: ___________________________________________

Please answer the following questions. If more space is required, please attach the additional page(s).

1.   Why are you applying for your child's enrollment in Covenant Love Community School?

2.   List your child's educational history, chronologically to date (including preschool and homeschool).

3.   List any academic, physical and/or psychological testing/screening administered to your child, to date.

4.   Can you provide transportation for your child in case difficulties arise in obtaining school bus services?

Parent Signature   ____________________________________     Date   __________

Please note that a completed application form is not a guarantee of admission, but only a request for admission.