Upton Lake Christian School

School Use Only Date Received ______Date Accepted ______Start Date ______UPTON LAKE CHRISTIAN SCHOOL PO Box 63, Clinton Corners, New York 12514 Phone 845-266-3497 Fax 845-266-3828 [email protected]

JUNIOR HIGH/HIGH SCHOOL ADMISSION APPLICATION

STUDENT INFORMATION

Name Sex______Date of Birth ______

Address School District ______

City State Zip Code______Grade to enter ______

Name/Address of last school attended ______

______Student’s Cell # ______

FAMILY INFORMATION

Fathers Name ______Email______

Employer______Work #______

Position Home Phone ______

Cell Phone______Marital Status ______

Mother’s Name______Email______

Employer______Work # ______

Position Home Phone______

Cell Phone______Marital Status______

List the names and grades of your children who are not applying. Please Explain.

______

What church are you currently attending?______Pastor’s Name______

Pastor’s Phone: ______Email______

Are you a member? Father______Mother______Applicant______

Are you a born-again believer? Father______Mother______Applicant______

MEDICAL INFORMATION

Family Physician: Phone #______

Address/City/Zip______

Does applicant have any physical defects, allergies, asthma? Inhaler or epi-pens?

If yes, please explain. ______

______

Have there been more than 15 absences from school this year? If yes, what was the primary reason?______

SCHOLASTIC INFORMATION

Please indicate the grades the applicant received on his or her most recent report card.

English Reading Math Spelling______

Science Soc Studies Bible Effort______

Does the applicant have an aptitude /interest in . . .

Art______Music______Band Sports______

Drama ______Pep Squad______

Has the applicant ever been required to repeat a grade? If so, please explain.

______

LEARNING NEEDS

Has the applicant received learning assessment testing or evaluation? ______

______

Has this ever been recommended by a teacher or school staff? ______

Do you think your student has any special learning needs? ______

______

BEHAVIORAL INFORMATION

Has the applicant ever been suspended or expelled from school, or refused admission to another school? If yes, please explain.______

______

Has the applicant had disciplinary difficulties in school? ______

______

Has the applicant ever been convicted of a crime? If yes, please explain.______

______

Has the applicant ever used tobacco? Alcohol?______Illegal drugs? ______

______

GENERAL INFORMATION

How did you hear about Upton Lake Christian School? ______

______

Why do you want a Christian education for your child? ______

______

Why are you applying to ULCS and not another Christian School? ______

______

Do you know a family that currently sends their children to ULCS? ______

______**** TO BE FILLED OUT BY THE STUDENT ****

What do you enjoy doing in your spare time? ______

______

How much television do you watch? ______

What shows do you watch? ______

What type of pleasure reading do you do? ______

Who is your favorite singer or group? ______

In what school activities have you participated? ______

______

How do you think a Christian school would be different from the school you are now attending?

______

What is meant by the term “born-again” Christian? ______

______

Do you want to attend Upton Lake Christian School?

Why? ______

______

 Please submit application with the non-refundable $50 application fee. I testify that the preceding information is true and accurate. I acknowledge that lack of information, misleading answers or falsification of information used in school admissions is subject to consequences of suspension and possible expulsion from ULCS.

Parent Signature Date