<p> 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]</p><p>JUNIOR HIGH/HIGH SCHOOL ADMISSION APPLICATION </p><p>STUDENT INFORMATION</p><p>Name Sex______Date of Birth ______</p><p>Address School District ______</p><p>City State Zip Code______Grade to enter ______</p><p>Name/Address of last school attended ______</p><p>______Student’s Cell # ______</p><p>FAMILY INFORMATION</p><p>Fathers Name ______Email______</p><p>Employer______Work #______</p><p>Position Home Phone ______</p><p>Cell Phone______Marital Status ______</p><p>Mother’s Name______Email______</p><p>Employer______Work # ______</p><p>Position Home Phone______</p><p>Cell Phone______Marital Status______</p><p>List the names and grades of your children who are not applying. Please Explain. </p><p>______</p><p>______</p><p>______</p><p>What church are you currently attending?______Pastor’s Name______</p><p>Pastor’s Phone: ______Email______</p><p>Are you a member? Father______Mother______Applicant______</p><p>Are you a born-again believer? Father______Mother______Applicant______</p><p>MEDICAL INFORMATION </p><p>Family Physician: Phone #______</p><p>Address/City/Zip______</p><p>Does applicant have any physical defects, allergies, asthma? Inhaler or epi-pens? </p><p>If yes, please explain. ______</p><p>______</p><p>Have there been more than 15 absences from school this year? If yes, what was the primary reason?______</p><p>SCHOLASTIC INFORMATION</p><p>Please indicate the grades the applicant received on his or her most recent report card.</p><p>English Reading Math Spelling______</p><p>Science Soc Studies Bible Effort______</p><p>Does the applicant have an aptitude /interest in . . . </p><p>Art______Music______Band Sports______</p><p>Drama ______Pep Squad______</p><p>Has the applicant ever been required to repeat a grade? If so, please explain. </p><p>______</p><p>______</p><p>LEARNING NEEDS</p><p>Has the applicant received learning assessment testing or evaluation? ______</p><p>______</p><p>Has this ever been recommended by a teacher or school staff? ______</p><p>Do you think your student has any special learning needs? ______</p><p>______</p><p>BEHAVIORAL INFORMATION</p><p>Has the applicant ever been suspended or expelled from school, or refused admission to another school? If yes, please explain.______</p><p>______</p><p>Has the applicant had disciplinary difficulties in school? ______</p><p>______</p><p>Has the applicant ever been convicted of a crime? If yes, please explain.______</p><p>______</p><p>Has the applicant ever used tobacco? Alcohol?______Illegal drugs? ______</p><p>______</p><p>GENERAL INFORMATION</p><p>How did you hear about Upton Lake Christian School? ______</p><p>______</p><p>Why do you want a Christian education for your child? ______</p><p>______</p><p>______</p><p>Why are you applying to ULCS and not another Christian School? ______</p><p>______</p><p>Do you know a family that currently sends their children to ULCS? ______</p><p>______**** TO BE FILLED OUT BY THE STUDENT ****</p><p>What do you enjoy doing in your spare time? ______</p><p>______</p><p>How much television do you watch? ______</p><p>What shows do you watch? ______</p><p>What type of pleasure reading do you do? ______</p><p>Who is your favorite singer or group? ______</p><p>In what school activities have you participated? ______</p><p>______</p><p>______</p><p>How do you think a Christian school would be different from the school you are now attending?</p><p>______</p><p>______</p><p>What is meant by the term “born-again” Christian? ______</p><p>______</p><p>______</p><p>Do you want to attend Upton Lake Christian School? </p><p>Why? ______</p><p>______</p><p>______</p><p>______</p><p> 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. </p><p>Parent Signature Date </p>