HBBC

Parent Admission Questionnaire

Grades K-12

Student's Name *

Last Name *

2. Briefly describe your reason for desiring your child to be a student at HBA: *

4. Does your child live with both parents? *

5. If parents are separated or divorced, who has legal custody?

6. What are the first 3 words that come to mind when describing your child? *

7. How would you describe your child's personality? *

Shy

Outgoing

Varied

8. How would you rate your child's response to correction? *

9. What are your child's principle interests and talents? Please describe your child's level of involvement in sports and musical, artistic or related co-curricular or extra-curricular activities. *

10. Describe the roles that your child plays in your family, including "responsibilities" as a family member. *

11. How would you describe your child's self esteem? *

12. Does your child receive any tutoring or academic enrichment outside of the classroom? If so, please explain. *

13. Has your child ever been asked to leave school? If yes, please explain. *

14. In order to assist us with our daily academic, fine arts, or spiritual growth programs, describe any physical or mental condition that might affect your child's participation. *

15. Does your child take medication that requires administration by the nurse during the school day? If yes, please explain. *

16. Has your child ever skipped a grade? If yes, what grade? Has your child ever repeated a grade? If yes, what grade? *

17. Does your child have a current IEP (Individual Education Plan)? If yes, please provide a copy with your application. *

Yes

No

18. Is there additional information that will help us in meeting your child's educational needs? *

19. In what ways have you participated in the academic life of your child's past schooling experience? *

20. How much time per week do you or someone from your household spend helping to study or complete your applicant's homework? *

22. Are there any current circumstances that would conflict with the financial requirements of this institution? If yes, please explain. *

23. What is the best means of communication for our school to send home important information? *

Letter/Note

Email

Text Message

Phone Call

Acknowledgement

Name of Applicant: *

Applying for Grade: *

Parent Acknowledgement

This is to acknowledge that I have authorized my child's current school to send copies of report cards and records to Heartland Baptist Academy.

In order for the Admissions Committee to consider my child's application for admission, I authorize Heartland Baptist Academy to contact schools and other sources to obtain information to support this application. I release every person and institution from any and all liability resulting from or pertaining to their furnishing records, documents, test results, and other information requested by Heartland Baptist Academy for the purpose of reviewing my child's application. I understand that all admission information is confidential, and that I will not seek access to recommendations, evaluations or other information used to determine my child's admission.

I understand that students are selected based on the results of the admission visit, school records, recommendations, and space availability. Applicants must be able to demonstrate average to above average academic, social, and emotional skills in order to be considered for placement in this school. I also understand that the Admissions Committee renders placement decisions after careful and thorough consideration of all data and that all placement decisions are final for the academic year under consideration.

Heartland Baptist Academy encourages parents of children with limitations or disabilities to fully disclose this information so that we may assist in the evaluation of their education needs. When appropriate, Heartland Baptist Academy will assist in reasonable accommodation.

Failure to respond honestly to the questions in this form may result in cancellation of the enrollment contract.

Heartland Baptist Academy practices a policy of nondiscrimination in employment and admission. We hire employees and admit students of either sex, and any race, color, non-disqualifying handicap and national or ethnic origin.

All responses for enrollment will be sent in the mail. All applicants accepted will be required to take a placement test.

By entering and signing your name, you are agreeing to the acknowledgement above.

Your Name *

Email *

Parent Signature *

Clear