SOAR Application for Homeschool

Student Information
Current Grade*
Date to Begin*
MM slash DD slash YYYY
Student's Legal Name*
First Last
Middle Name*
Nickname
Student's Address
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Date of Birth*
MM slash DD slash YYYY
Age*
Gender*
- Male
- Female
With whom does the student live?*
Relationship to the student?*

Enrollment
There is a $60 enrollment fee due with application. You must submit this fee for your child to be enrolled.
Payment Plan*
- 1 Payment of $2,160 due on September 1
- 9 Payments of $240 due monthly on the 1st, September through May
By signing below, I/we agree to pay all tuition and fees in accordance with the selected payment plan.*

How did you become interested in WCA?*
- Family / Friend
- Pastor
- Internet
- Advertisement
- Sign
Describe your child's interests, talents and abilities*
What are the specific learning needs of your child?*
Current educational program*
Last school attended (if applicable)
School Address/Phone
Has the student ever been retained in a grade?*
Does the student receive special student services, have an IEP (Individualized Education Plan) or 504 plan?*
Does the student regularly require medication related to learning/attention?*
Has the student even been...
- Suspended
- Expelled
- Asked to Withdraw

Parent Statements
Because our mission is to provide Christian Education to Christian families we ask that each parent provide a statement describing your personal faith in Jesus Christ.
Father
Mother
Please list names of anyone other than the parents who will be picking the child from SOAR.
References
Please list the names and phone numbers of two families (preferably one WCA family) who knows you well. Do not list relatives.
Reference 1 Name*
First Last
Reference 1 Phone*
Reference 2 Name*
First Last
Reference 2 Phone*
Spiritual Background
Name of church your family/student attends
Address
Street Address City State / Province / Region ZIP / Postal Code
Years Attending
Pastor's Name
First Last
Youth Pastor's Name
First Last
What is the frequency of your family's attendance
- Weekly
- Frequently
- Infrequently
Emergency Contact Information
In the event of an emergency where we are unable to reach the parents, please list the name of the person you would like for us to contact.
Name
First Last
Phone

Student Information