ONLINE APPLICATION

For Grade*
School District
Today's Date
Name*
First Middle Last
Home Address*
Street Address Address Line 2 City State / PR ZIP / Postal Code Country
Home Phone*
Date of Birth*
Gender*
- Male
- Female
Race
- Asian
- Black
- Caucasian
- Native American
- Hispanic
Requested by NYS

Mother's Information
Mother's Name
Occupation
Employer
Work Phone
Cell Phone
Father's Information
Father's Name
Occupation
Employer
Work Phone
Cell Phone
Primary Email*
Child Lives With*
Marital Status of Parent(s)*

Present Grade*
Current School*
School Address*
Street Address Address Line 2 City State / PR ZIP / Postal Code Country
Has your child ever been recommended for any type of specials needs class?*
- Yes
- No
If yes, please describe:
Is your child currently receiving additional help outside the classroom such as tutoring, reading help, speech or language therapy?*
- Yes
- No
If yes, please describe:
Has your child had any problems with discipline at school?*
- Yes
- No
If yes, please describe:

First person to contact in an emergency:*
Relation to child:*
Phone*
Second person to contact in an emergency:
Relation to child:
Phone
Does your child have any allergies or other health conditions?*
- Yes
- No
If yes, please describe:
Child's Doctor
Phone
Do you have other children currently applying to CCA?*
- Yes
- No
Name
Grade
Name
Grade
Name
Grade

Do you regularly attend Calvary Chapel of the Finger Lakes?*
- Yes
- No
If yes, how long have you been in regular attendance?
Which services do you attend?
Make multiple selections by Ctrl+click (PC) or Cmd+Click (Mac)
Do you attend another church?
- Yes
- No
It yes, where?
Please list the ministries and activities that you are involved in at your church:
Parents: Please describe briefly, your personal relationship to Jesus Christ:*
Parent completing this section:*
Parents: What do you see as your biblical responsibility in your child’s education? Also, why do you want your child(ren) at CCA?*
Parent completing this section:*
Students applying for grades 3 through 8: Please write a brief statement describing your personal relationship with Jesus Christ. Also, why do you wish to attend Calvary Chapel Academy?*
Student Signature (Typed)*
Parent Signature (Typed)*
I certify to the best of my ability that the information throughout this application is complete and accurate.
Date
All applicants must submit copies of their their most recent report cards as well as report cards from all previous years.

All applicants must include copies of their most recent standardized test scores, and any IEP or 504 information.

Have a pastor who knows you well complete the Pastoral Reference Form.

Acceptance will only be considered once all required items have been received and the student has met with one of our faculty.

Mailing address for attachments: Calvary Chapel Academy P.O. Box 25099, Farmington, NY 14425

Step 1 of 5 - STUDENT INFORMATION

Mother's Information

Father's Information