Date of application:

Grade level desired:

Term desired:

Fall 2018 only

Spring 2018 only

Full year 2018 / 2019

Summer 2018

STUDENT INFORMATION

Surname/Primary Name

Given Name

Male                                 Female

Preferred Name

Passport Name

Date of Birth

Admission Number

Form Issue Reason

Address:

Email:

Phone:

Current School:

Current grade:

Year of

Level:

graduation:

PARENT INFORMATION

Father:

Mother:

Marital status:

Marital status:

Address:

Address:

Phone:

Phone

Email:

Email:

Occupation:

Occupation:

U.S. CONTACT INFORMATION  if available

Name:

Address:

Phone:

Email:

Agency:

Address:

Phone:

Email:

Name:

English Name:

Where do you currently go to school?

What are some things you like about your school?

What are some things you would like to change at your school?

Have you ever been suspended, dismissed or expelled?  Please explain.

Have you ever failed a grade level?  Please explain.

Who is your favorite teacher? What is your favorite subject?

Describe any awards or honors you have received at your school.

Name:

English Name:

Describe any clubs, organizations or sports you participate in.

Do you plan to continue your education after secondary school?  Where would you like to do that?

What are your plans for a future career?

Why do you want to attend Heritage Christian Academy?

Describe your religious beliefs.  What do you know about Christianity?  Do you believe in God?

What church do you attend?  Describe your volunteer positions at your church.

Are you willing to attend religious services and events with a host family?  How often will you do this?

Who are the family members that you live with?

What do you like to do with your family for fun or vacations?

Name:

English Name:

How would your friends describe you?  What do you like to do when you're with your friends?

Do you work to earn money?  Where do you do this?  Do you volunteer in your community? 

Describe your volunteer positions.

Will you be staying with a host family?  Describe the ideal host family.  What do they like to do together?

Do they eat meals together?

Are you willing to live with American brothers and/or sisters?  What ages are best?

What are some things you wish to avoid with a host family?  Are family pets okay?  Are you willing to share a

bedroom or bathroom?

What are some things you are looking forward to as a student in the U.S.?

Do you have any concerns about being a student in the U.S. or about attending Heritage Christian Academy?