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Request Information

Thank you for your interest in our school!

Please fill out the form below and our Admissions Office will contact you and provide the information you desire.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us? *
    Details:

  • What is your religious affiliation? ((Baptist,etc.) Please keep in mind that our school is for those that are of "like-faith"
    *

  • Parent's testimony of salvation:
    *

  • Student's Testimony of Salvation:
    *

  • What church are you a currently a member of?
    *

  • What Church are you currently a member of: (Membership at a church of like-faith is a requirement for enrollment)
    *

  • What is the name of the school your student currently attends?
    *

  • What School District do you reside in?
    *

  • Has your student been dismissed from attending any schools in the past:? If so, please give the reason why:
    *

  • Does your student have a current and active IEP?  Is yes, please give an detailed explanation of what the IEP is for? What are their current accommodations and/or modifications?
    *
  •  
  • Student 1
  • First Name *
    Middle Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •