Student Information
Family Information
Agreements
Finish Up

Name

Application Details

Date of Application *

Academic Year *

Grade Entering *

Student Details

Student's Full Name *

Sex *

Male Female

Phone Number *

Church Membership *

Church Address *

Pastor *

Full Street Address *

City *

State *

Zip *

Birthdate *

Birthplace *

Ethnicity *

Age *

Educational History

List, in order, schools previously attended. Begin with most recent. *

In the space above, please list the name, city, grades attended and reason for leaving for any previously attended schools

Which public school would the student normally attend? *

Has the student ever been suspended or expelled? *

Yes No

Does the student have a documented learning disability? *

Yes No

Family Information

Father

Include father in application consideration? *

Yes No

Father's Name *

Cell Phone *

Email Address *

Street Address

(If different than student)

City

State

Zip

Employer's Name *

Employer's Address *

Employer's Phone *

Church Membership

(If different than student)

Pastor

Highest College Degree *

Years of Education Completed *

Mother

Include mother in application consideration?

Yes No

Mother's Name *

Cell Phone *

Email Address *

Street Address

(If different than student)

City

State

Zip

Employer's Name *

Employer's Address *

Employer's Phone *

Church Membership

(If different than student)

Pastor

Highest College Degree

Years of Education Completed

Does this student have and additional guardian? *

Yes No

Does this student have any siblings? *

Yes No

Student Agreement

I desire to receive a Christian Education at Victory Christian Academy *

Yes No

I am committed to follow the rules, to work hard and to help maintain a Christ-centered atmosphere at school. *

Yes No

Student Signature *

Please enter your name in the box above

Date *

Parent Agreement

We herewith concur with the enrollment of our student and accept all school regulations as set forth in the Handbook. We understand that the registration fee for enrollment is non-refundable. In order to assure the best possible success of our student at Victory Christian Academy, we will support the school in Christian training in every way possible. We understand that this application will not be officially considered or processed for admission until all paperwork and registration fee is received by the school. We understand our financial responsibility, the school refund policy and are committed to meeting tuition obligations fully and in a responsible and timely fashion. We understand that each enrollment is for one year at a time. We have fully informed the school of any physical, emotional or educational disabilities our student may present and any special needs required. We certify that all statements made on this enrollment form are correct, accurate and complete. We will work hard to support the teachers and the general mission of the school through prayer and participation. *

Yes No

Father's Signature *

Please enter your name in the box above

Date *

Mother's Signature *

Please enter your name in the box above

Date *

Will payments of tuition be made by one or more of the person(s) listed above? *

Yes No

Which of the following payment schedules would you prefer? *

Yearly - due July 1st

Split - due July 1st and Dec. 1st

Monthly - due monthly, July through May

How did you hear about Victory Christian Academy? *

Elementary School

Church

Internet Search

Phone Book

Victory Alum

Another Victory Family

Other

What were the primary factors in your decision to apply to Victory? *

Did you know we offer referral incentives?

Any additional files you need to upload?

Enroll at Victory

Application Details

Student Details

Educational History

Family Information

Father

Mother

Student Agreement

Parent Agreement

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