APPLICATION FOR ENROLLMENT
EAGLES’ WINGS CHRISTIAN ACADEMY
3919 North Monticello Ave., Chicago, Illinois 60618-4127
773-297-6326 Fax 773-202-8193
Date of Application ______________________
Expected Start Date ______________________
Applicant Information
Name ____________________________________________________________ Entering grade _________________
Last First Middle
Nickname (if used) ____________________________ Student Email________________________________________
Social Security #_______-____-________or TIN#__________________________ or VISA#______________________
(required)
Country of Birth __________________________________Applicant’s primary language ________________________
Does applicant speak English? _____________ Fluent _____________ Good _______________ Poor ______________
Home address ___________________________________________________________________________________
Number Street Apt # City Zip Code
Phone _________________________________ Message Phone ___________________________________________
Age _______________ Birth Date ________/________/________ Male_________Female ________
Last School Attended ____________________________________________ Phone ____________________________
Address _________________________________________________________________________________________
Date of withdrawal________________ Reason for withdrawal ______________________________________________
_______________________________________________________________________________________________
Referred to EAGLES’ WINGS by _____________________________________________________________________
Family Information (All information is required for both parents.)
Father’s name _________________________________________________________________________________
Last First Middle
Social Security #_______-____-________or TIN#__________________________ or VISA#______________________
(required)
Occupation _______ _______ How long? ________________________________
Employer _______________________________________________ Work phone ______________________________
Current
Employer’s address ______________________________________________________________________________
Number Street City Zip Code
Email (required) ____________________________________________ Primary Language ______________________
If English is not your native language, mark how well do you understand:
EXCELLENT GOOD FAIR POOR
Conversation ______________ _________ ___________ _____________
Written ______________ _________ ___________ _____________
Mother’s name _________________________________________________________________________________
Last First Middle
Social Security #_______-____-________or TIN#__________________________ or VISA#______________________
(required)
Occupation _______________ How long? _______________________________
Employer _______________________________________________ Work phone ___________________________
Current
Employer’s address _____________________________________________________________________________
Number Street City Zip Code
Email (required) ___________________________________________ Primary Language ________________________
If English is not your native language, mark how well do you understand:
EXCELLENT GOOD FAIR POOR
Conversation ______________ _________ ___________ _____________
Written ______________ _________ ___________ _____________
Does father_________ or mother _________ require a translator? Conversation ___________ Reading______________
Applicant lives with: Father __________ Stepfather _________ Other __________
Mother __________ Stepmother ________
Parents are:
Married and living together __________
Never married __________
Separated _____________ age of child at separation ____________
Divorced ______________ age of child at divorce _______________
Father deceased _______ age of child at father’s death __________
Mother deceased _______ age of child at mother’s death _________
Additional children in family:
Name Age Living with applicant now? Ever?
________________________________ __________ ______________________ __________
________________________________ __________ ______________________ __________
________________________________ __________ ______________________ __________
________________________________ __________ ______________________ __________
________________________________ __________ ______________________ __________
________________________________ __________ ______________________ __________
Church Information
Have you made a personal commitment to Jesus Christ as Lord and Savior?
Father ____________ Mother _____________ Applicant _____________
Do you regularly attend: CHURCH SUNDAY SCHOOL TRAINING or BIBLE CLASS
Father _________ _________ _________
Mother _________ _________ _________
Applicant _________ _________ _________
Church you presently attend ________________________________________________________________________
Address______________________________________________________ Phone _____________________________
Pastor’s Name____________________________________________________________________________________
Are you a member? _____________ Regularly Attend _____________ Attend Occasionally _____________
Student Profile
Has the applicant had any learning, emotional, or behavioral problems? ________ If yes, please describe: ____________
________________________________________________________________________________________________
________________________________________________________________________________________________
Does the applicant have a history of serious discipline problems? ________ If yes, please explain. __________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Has the applicant ever been retained in a grade?__________________ If yes, which grade and why? ________________
________________________________________________________________________________________________
Academic work last year was Excellent ____________ Good _____________ Fair ____________ Poor ______________
Has your child ever received any of the following:
Tutoring________________ Subject(s) _______________________________________________________________
Psychological Evaluation ___________________________________________________________________________
Counseling ______________ Where _______________________________________ How long __________________
Special Education Evaluation ___________ IEP__________ When _____________Hearing Evaluation______________
Vision Therapy___________________ Physical Therapy___________________ Speech Therapy__________________
Briefly describe the applicant’s personality, abilities, and interests___________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Why do you wish to send your child to EAGLES’ WINGS? _________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
References for applicant:
Teacher _________________________________________________________________________________________
Name Address
Phone ___________________________________ Email _________________________________________________
Youth Pastor/Mentor____________________________________________________________________________________
Name Address
Phone ___________________________________ Email _________________________________________________
STATEMENT OF COOPERATION
I hereby verify the above information to be accurate, complete, and truthful. Initial _____/_____
Father /Mother
I absolve the school of any liability due to injury or accident at school or during normal school activity. Initial _____/_____
Father/Mother
I give permission for my child to take part in all school activities, including sports and school-sponsored trips away from the premises, and I absolve the school of any liability due to injury or accident during such activities. Initial _____/_____
Father/Mother
I understand that school policy states that no refunds will be made on registration or book fees, or for tuition for any Quarter in which my PreK -8th child has attended school, or any Semester in which my 9-12th grade student has attended school. Initial _____/_____
Father/Mother
I understand that it is essential to the proper functioning of the school that all fees and tuition payments be made on time and I agree to make faithful and timely payments. I understand that, should my child withdraw from Eagles’ Wings, or upon graduation, no school records or transcripts will be forwarded until all charges are paid in full. Initial _____/_____
Father/Mother
I understand and agree that the wise and effective foundations of Biblical child training hold parents responsible to establish respect, honor, love, and obedience in the lives of their children. I understand that the school expects my child to have had respect, honor, love, and obedience toward God and His Word; and for parents, pastors, and teachers established at home. I understand that kindness, respect, honor, and obedience will be expected of my child at school and that it is my responsibility to promote my child’s growth in these godly characteristics. I understand that corrective consequences will be given and, very rarely, corporal punishment with parental knowledge/involvement may result for serious (habitual) disobedience or disrespect. I agree to uphold any discipline deemed necessary by the teacher or the admnistration. Initial _____/_____
Father/Mother
I understand and agree that none of God’s loving and protective commands to us as His beloved children are exempt from our required obedience and repentance, no matter how “acceptable” some choices and behaviors have become in society. I agree to teach and model for my child that all lying, swearing, sexual deviance, sex outside of marriage, unmarried co-habitation, civil law-breaking, and music/movies/TV/ Internet that promote violation of God’s commands are unacceptable, without exception. Initial _____/_____
Father/Mother
Understanding that tuition and fees are not sufficient to cover the cost of private education, I recognize and agree that participation in parent activities and fundraising is essential and is my responsibility. I agree to attend Parent-Teacher Conferences, Parent Nights, our International Dinner and other gatherings and activities; and to offer help, service, and support for school fundraising activities. Initial _____/_____
Father/Mother
I understand that all families contribute 20 hours of Parent Participation per year to help reduce the cost of an excellent education. I agree to pay $10/hr at the end of the year for un-served hours. Initial _____/_____
Father/Mother
I understand that all students are accepted on a nine-week trial basis. Initial _____/_____
Father/Mother
I have completed all information in this application and have given careful thought to the Statement of Cooperation and do hereby request EAGLES’ WINGS CHRISTIAN ACADEMY to process this application for admission for my child.
________________________________________ _____________
Parent’s signature Date
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