international boarding student application checklist · application checklist admission checklist...
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1 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
International Boarding Student
Application Checklist
Admission Checklist – Submit all Admission forms to [email protected] or mail to the Admissions
Office at the academy address.
Online Application or Paper Application
Application Fee $50.00
o Pay by credit card using the International Application Fee Form
o Pay by wire transfer using Peer Transfer
www.thekingsacademy.peertransfer.com
Student Questionnaire Supplement
Official Transcripts Translated into English (Please submit the Permission to Release Student Records Form to
the student’s current school.)
Official English Proficiency Test Scores
The Office of Admissions will contact the student references and request they complete School Reference Forms
(See Page 10)
Interview (Skype)
The Academy will send an Acceptance Decision Letter
o Priority Dates: Applicants who submit applications by February 15 for the subsequent school year will
receive notification of an acceptance decision by March 10.
o If the applicant is accepted, enrollment instructions will be given.
2 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
The King’s Academy
202 Smothers Rd.
Seymour, TN 37865
865-573-8321
Boarding Student Application
Student Name: ________________________________________ Academic Year: _______________ Grade: ________
Applicant Information
Full Name: ______________________________________________________________________________
Nickname: __________________________________ Birth Date: ____________________
Street Address: __________________________________________________ City: ____________________
State/Province: _________________ Zip: _______________ Country: _______________________________
Email Address: ___________________________________________________________________________
Home Phone: _________________________ Cell Phone: ________________ Student Gender: M F
Student Ethnicity: _____________________________ Student Citizenship: ___________________________
Primary Language Spoken at Home: _________________________ Birth City: ________________________
Birth State: __________________ Birth Country: __________________________
How did you hear about us? ________________________________________________________________
Please tell us why you are applying to The King’s Academy.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
When do you plan to begin attending The King’s Academy? Please state the month and year. _____________
Dual Citizenship Country (if applicable): ________________________________________________________
Is the student a permanent resident of the United States? Yes No
If you are a permanent resident: Please provide a copy of the student’s permanent resident card. What is
your alien registration (green card) number? _______________________________________
What is your alien registration (green card) expiration date? _____________________________
If you are not a permanent resident: Are you applying for an F-1 (student) visa? Yes No
Are you currently attending a school in the United States? Yes No
Have you ever viewed The King’s Academy Facebook Page? Yes No
Have you ever seen the King’s Academy on Twitter? Yes No
3 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Previous Schools Most Recent/Previous School Attended
School Name: ____________________________________________________________________________
Street Address: ___________________________________________________________________________
City: ______________________________ State: _________ Zip: ______________ Phone: ______________
From Date: ________________________ To Date: _______________________ Grade Completed: ________
Second Most Recent/Previous School Attended
School Name: ____________________________________________________________________________
Street Address: ___________________________________________________________________________
City: ______________________________ State: _________ Zip: ______________ Phone: ______________
From Date: ________________________ To Date: _______________________ Grade Completed: ________
Has the applicant ever been dismissed or suspended from school? Yes No If yes, please explain:
________________________________________________________________________________________
________________________________________________________________________________________
Has the applicant ever had incidents of school truancy? Yes No If yes, please explain:
________________________________________________________________________________________
________________________________________________________________________________________
Religious Affiliation
Religious Affiliation: ________________________ Current Place of Worship: __________________________
Phone: ______________________ City: ____________________________ State: ________ Zip: _________
Pastor: _______________________________________________________ Church Member? Yes No
Is the applicant a Christian? Yes No
Please discuss the applicant’s involvement in church (if applicable): __________________________________
________________________________________________________________________________________
________________________________________________________________________________________
4 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Additional Student Information
Does the applicant have any disability, impairment, or condition that may represent a health or safety risk for
the student or others, or which should or may restrict the student’s activity? Yes No If yes, please explain:
________________________________________________________________________________________
________________________________________________________________________________________
Has the applicant ever been diagnosed by a qualified professional to have a medical or emotional condition
that requires continuous medication? Yes No If yes, please describe the condition: __________________
________________________________________________________________________________________
________________________________________________________________________________________
Please list all prescribed medications, dosages, and reasons for taking.
________________________________________________________________________________________
________________________________________________________________________________________
Has the student every received an educational, psychological or “504” evaluation, or an individualized
educational plan (IEP), or has the student ever been referred, or qualified for special education services?
Yes No If yes, please explain. Send a scanned copy of test results to [email protected]
or mail a copy to the Office of Admissions.
________________________________________________________________________________________
________________________________________________________________________________________
Have you suspected that a learning handicap condition exists? Yes No If yes, please explain:
________________________________________________________________________________________
________________________________________________________________________________________
Has the applicant ever skipped a grade? Yes No If yes, what grade was skipped? ___________________
Has the applicant ever been tested for a gifted program? Yes No
Has the applicant ever been retained? Yes No If yes, what grade was repeated? _________________
Please list the student’s involvement in co-curricular activities (sports, music, art, drama, etc.)
________________________________________________________________________________________
________________________________________________________________________________________
Please discuss the applicant’s attitude toward and history of the following (add an explanation if needed):
Tobacco: ________________________________________________________________________________
Alcohol: _________________________________________________________________________________
Other Drugs: _____________________________________________________________________________
5 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Has the applicant had any serious illnesses, serious injuries, hospitalizations and operations including
rehabilitation admissions and chemical dependency or behavioral treatment programs? Yes No
If yes, please explain and include dates and types of admissions: ____________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Has the applicant ever had any instances of theft? Yes No If yes, please explain: ____________________
________________________________________________________________________________________
Has the applicant had any incidents of fighting? Yes No If yes, please explain: ______________________
________________________________________________________________________________________
Has the applicant ever had any involvement with legal authorities? Yes No If yes, please explain:
________________________________________________________________________________________
________________________________________________________________________________________
Has the applicant ever been referred to or received the services of a professional counselor? Yes No
If yes, please explain: ______________________________________________________________________
________________________________________________________________________________________
6 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Household 1 Please answer the following questions about the applicant’s Primary Family or Custodial Household.
Parents who reside at two different addresses: Please fill out the enrollment responsible parent’s information ONLY below.
Home Address
Street Address: ___________________________________________________________________________
City: ________________________________________ State: ___________ Zip: _____________
Country: _____________________ Home Phone: _________________
Parent/Guardian One Parent/Guardian Two
Last Name
First Name
Middle Name
Suffix
Salutation
Gender
Relationship to Applicant
Custodial Rights? Yes No Yes No
Financial Responsibility? Yes No Yes No
Receive Correspondence? Yes No Yes No
Marital Status
Email 1
Email 2
Work Phone
Cell Phone
Occupation
Employer
Employer City
Employer Zip
Current Church
Highest Level of Education
Degree
7 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Does the applicant have a parent/guardian that lives at another address? Yes No If yes, please answer
the following questions about the Secondary Family or Custodial Household. If no, please skip to Siblings.
Household 2
Home Address
Street Address: ___________________________________________________________________________
City: ________________________________________ State: ___________ Zip: _____________
Country: _____________________ Home Phone: _________________
Parent/Guardian One Parent/Guardian Two
Last Name
First Name
Middle Name
Suffix
Salutation
Gender
Relationship to Applicant
Custodial Rights? Yes No Yes No
Financial Responsibility? Yes No Yes No
Receive Correspondence? Yes No Yes No
Marital Status
Email 1
Email 2
Work Phone
Cell Phone
Occupation
Employer
Employer City
Employer Zip
Current Church
Highest Level of Education
Degree
8 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Siblings
Sibling 1
Sibling Name: _____________________________________ Age: __________ Date of Birth: _______________________
Grade: __________ Current School: _____________________________________________________________________
Sibling 2
Sibling Name: _____________________________________ Age: __________ Date of Birth: _______________________
Grade: __________ Current School: _____________________________________________________________________
Sibling 3
Sibling Name: _____________________________________ Age: __________ Date of Birth: _______________________
Grade: __________ Current School: _____________________________________________________________________
Alumni or Currently Enrolled Students
Does the applicant have any other relatives who currently attend, have attended, or have graduated from The
King’s Academy? Yes No If yes, who? _____________________________________________________
Statements of Commitment
When an applicant is accepted, a deposit is required and is payable through the online enrollment system. This deposit constitutes evidence of good faith in binding this agreement and can apply to the student's account. I understand that such deposits, except for deposits for international students applying for student visas, are non-refundable after one month prior to the school term for which the student is applying.
I understand that, in the event the student withdraws enrollment or is dismissed from the Academy during the course of a school year, tuition for the complete current grading period is due, payable, and will not be refunded. Students whose accounts are more than 60 days past due are subject to dismissal. Accounts must be current before the student will be permitted to participate in designated co-curricular activities or take semester exams, and before student records will be released.
Parent Signature: ___________________________________________________ Date: _________________
I understand the philosophy and purpose of The King's Academy. I understand that the Academy is a distinctively Christian school. As such, its students are expected to pattern their life-styles after the model of Jesus Christ. Academy students who may not be personally committed to Jesus Christ are strongly encouraged by the Academy to make this commitment. I understand that the Academy forbids the use of tobacco, alcoholic beverages, and other non-prescribed controlled substances. I also understand that cheating, lying or the violation of any criminal or civil law shall be construed as a violation of Academy policy. I understand that these Academy rules apply both on and off campus, and that Academy students are expected to uphold the standards of the Academy at all times and in all places. I certify that the statements made in this enrollment packet are true and complete to the best of my knowledge. I also understand that falsification, withholding pertinent information, or failure to comply with Academy regulations may result in dismissal.
Parent Signature: ___________________________________________________ Date: _________________
9 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Statement of Faith
The academy affirms and teaches:
The Holy Bible as the inspired, infallible, authoritative word of God.
There is one God, eternally existent in three persons: Father, Son and Holy Spirit.
The deity of the Lord Jesus Christ, His virgin birth, His sinless life, His miracles, his vicarious and atoning death through His shed blood, His bodily resurrection, His ascension to the right hand of the Father and His personal return in power and glory.
For salvation of los and sinful man, regeneration by the Holy Spirit is absolutely essential.
The present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life.
The resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation.
The spiritual unity of believers in the Lord Jesus Christ.
Parent Signature: ___________________________________________________ Date: _________________
10 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Applicant References
1. Please list the Name, Title, Phone, and E-mail for the following references for this applicant. 2. The Office of Admissions will contact each person and ask them to complete a reference form and send
it back to the Office of Admissions.
Principal/Guidance Counselor
Name
Title
Phone Number
Email Address
English Teacher
Name Title Phone Number Email Address
Math Teacher
Name Title Phone Number Email Address
Family Friend
Name Title Phone Number Email Address
Minister/Christian Leader (if applicable)
Name Title Phone Number Email Address
11 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Statements of Commitment
When an applicant is accepted, a $15,000 deposit is required. This deposit constitutes evidence of good faith in binding this agreement and will apply to the student's account. I understand that such deposits, except for deposits for international students applying for student visas, are non-refundable after one month prior to the school term for which the student is applying.
I understand that, in the event the student withdraws enrollment or is dismissed from the Academy during the course of a school year, tuition for the complete current grading period is due, payable, and will not be refunded. Students whose accounts are more than 60 days past due are subject to dismissal. Accounts must be current before the student will be permitted to participate in designated co-curricular activities or take semester exams, and before student records will be released.
Parent Signature: ___________________________________________________ Date: _________________
I understand the philosophy and purpose of The King's Academy. I understand that the Academy is a distinctively Christian school. As such, its students are expected to pattern their life-styles after the model of Jesus Christ. Academy students who may not be personally committed to Jesus Christ are strongly encouraged by the Academy to make this commitment. I understand that the Academy forbids the use of tobacco, alcoholic beverages, and other non-prescribed controlled substances. I also understand that cheating, lying or the violation of any criminal or civil law shall be construed as a violation of Academy policy. I understand that these Academy rules apply both on and off campus, and that Academy students are expected to uphold the standards of the Academy at all times and in all places. I certify that the statements made in this enrollment packet are true and complete to the best of my knowledge. I also understand that falsification, withholding pertinent information, or failure to comply with Academy regulations may result in dismissal.
Parent Signature: ___________________________________________________ Date: _________________
Statement of Affirmation
I certify that the statements made in this application packet are true and complete to the best of my knowledge. I also understand that falsification, withholding pertinent information, or failure to comply with Academy regulations may result in termination of enrollment.
Parent Signature: ___________________________________________________ Date: _________________
Release of Records
I waive my right to access confidential information contained in my child’s admission file.
Parent Signature: ___________________________________________________ Date: _________________
12 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
The King’s Academy
202 Smothers Road
Seymour, TN 37865-5056
Telephone: 865-573-8321 Fax: 865-573-8323
Application for Admission
Student Questionnaire Supplement
(To be completed by the student in his or her own handwriting and returned by fax or email.)
Name _____________________________________________________ Date______________
Please answer the questions below as completely as possible.
Please check the statement that best describes your understanding of Christianity.
__ I am a Christian. (Start with question 1.)
__ I know something about Christianity, but I would not say that I am a Christian. (Skip to question 3.)
__ I do not know anything about Christianity. (Skip to Question 3.)
1. A. Discuss your experience in your relationship with Christ.
B. Discuss how your Christian commitment would relate to your role as a student at The King’s Academy.
2. A. With which denomination are you affiliated?
B. How long have you had this affiliation?
C. Is this your family’s religious affiliation?
D. To what extent are you involved or an active participant?
13 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
3. A. With which religious group are you affiliated, if any?
B. How long have you had this affiliation?
C. Is this your family’s religious affiliation?
D. To what extent are you involved or an active participant?
4. The King’s Academy is a Christian university preparatory school. This means that the rigorous academic
curriculum is taught from a Biblical worldview and all academy students are required to take Bible classes (one class
per year) and participate in weekly chapel on campus. All boarding students attend weekly church services on
Sunday mornings. Academy students who may not be personally committed to Jesus Christ are strongly encouraged
by the Academy to make this commitment.
A. If you attend The King’s Academy, will you be open to learning about Christianity?
B. If you attend The King’s Academy, will you be willing to uphold the Christian standards of the academy?
5. Why do you wish to attend The King’s Academy? Explain if you are applying at the request of someone else.
6. In what activities do you participate with your church, school or community?
7. What has been your involvement with tobacco, alcohol or other drugs?
8. Discuss your academic strengths and weaknesses. What subjects do you enjoy most and which ones do you like
least?
9. Where do you want to be and what do you want to be doing ten years from now?
14 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
The King’s Academy
INTERNATIONAL APPLICATION FEE FORM
Please complete and return this form to the Office of Admissions if you prefer to pay the application
fee by credit card.
Student Name: ______________________________________ Term Enrollment: ☐Fall ☐Spring
Date of Birth: ____________________ Year of Enrollment: __________
Gender: ☐ Male ☐ Female
PERSON RESPONSIBLE FOR PAYMENT OF ACCOUNT: ☐Parent ☐Guardian
Name: __________________________________________ Telephone: ______________________________
Address: ________________________________________________________________________________
_____________________________________________________ Country: ___________________________
Email address: ____________________________________________________________________________
Parent/Guardian Signature: __________________________________________________________________
TO PAY BY CREDIT CARD: ☐VISA ☐MASTER CARD
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Amount: __US$50.00________
3 - Digit Authorization Code: __________ Expiration Date:___/___/___
Name on Card: ___________________________________________________________________________
Signature Required: _______________________________________________________________________
FOR OFFICE ONLY:
Application Fee Amount: ___US$50.00____________ Date Received: ___/___/___
Treasurer’s Signature: ______________________________________________________________________
Application fee is not refundable. Please email a scanned copy of the completed form to
[email protected] or fax to 865-579-1184. Thank you.
15 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]
Permission for School to Release Student Records
Note: Please forward to previous school official and request that official transcripts be
mailed to The King’s Academy.
Name of Applicant ______________________________________________
The above named student is applying for admission to The King’s Academy,
Seymour, Tennessee.
In order for the application to be considered, I authorize the release of my child’s
records as requested by The King’s Academy. Please include all cumulative academic
and social records, test scores, and medical and immunization records.
Please send to: Admissions Office
The King’s Academy
202 Smothers Rd.
Seymour, TN 37865-5056
U.S.A.
_________________________________________________ ______________________
Signature of Parent or Guardian Date