Application Form

In addition to filling out this online application, you will also need to submit the items listed on the application process page. Please fill out a complete application--an asterisk (*) indicates a field that must be completed for the form to be submitted.

Applying for Grade: *

Beginning Semester: *

School Year: *

Student

First Name: *

Middle Name:

Last Name: *

Street Address: *

City: *

State: *

Postal Code: *

ZIP/Postal Code

Gender: *

Birth Date*

Email:

Home Phone: *

Cell Phone:

School

(to be completed by parent/guardian)

School last attended: *

Phone: *

Current School Corporation:

Has your child received assistance for any special learning needs in the past?: *

Yes

If yes, please describe briefly the nature of the assistance:

Family

Father/Male Guardian

First Name:

Middle Name:

Last Name:

Relationship:

Street Address:

State:

City:

ZIP/Postal Code:

Home Phone:

Work Phone:

Cell Phone:

Work Email:

Home Email:

Employer:

Job Title:

BCS Alum?:

Select graduating year if you are a BCS alum

Mother/Female Guardian

First Name:

Middle Name:

Last Name:

Street Address:

City:

State:

ZIP/Postal Code:

Home Phone:

Work Phone:

Cell Phone:

Work Email:

Home Email:

Employer:

Job Title:

BCS Alum?:

Select graduating year if you are a BCS alum

Paternal Grandparents

Grandfather's Last Name:

Grandfather's First Name:

Grandfather BCS Alum:

Grandmother's Last Name:

Grandmother's First Name:

Grandmother BCS Alum:

Street Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Maternal Grandparents

Grandfather's Last Name:

Grandfather's First Name:

Grandfather BCS Alum:

Grandmother's Last Name:

Grandmother's First Name:

Grandmother BCS Alum:

Street Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Siblings

1st Sibling

Click the links below to add additional siblings

Name:

Birth date

Current School:

Grade Level:

2nd Sibling

Name:

Birth date

Current School:

Grade Level:

3rd Sibling

Name:

Birth date

Current School:

Grade Level:

4th Sibling

Name:

Birth date

Current School:

Grade Level:

Faith and Church Life

Home Congregation:

Denomination:

Street Address:

City:

State:

Postal Code:

Phone:

Pastor:

Youth Leader:

What do Christ and the Christian faith mean to you at this stage in your life?:

Why do you wish to study at Bethany Christian Schools?:

What goals do you hope to reach as a Bethany student, and how do you plan to reach those goals?:

Ethnicity and Race

The federal government mandates that schools ask all students to answer the following two questions (Bethany uses the data only for state- and federally-sponsored statistical data collections that require data on ethnicity or race). Bethany Christian Schools admits qualified students of any race, color, and national or ethnic origin.

Is the student Hispanic or Latino?:

Yes, Hispanic/Latino

No, not Hispanic/Latino

(a person of Cuban, Mexican, Puerto Rican, South/Central American, or other Spanish culture or origin, regardless of race)

What is the student's race (choose one or more that apply):

American Indian or Alaska Native: a person having origins in any of the original peoples of North America and maintaining cultural identification through tribal affiliation or community recognition

Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the India subcontinent

Black or African American: a person having origins in any of the black racial groups of Africa

Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands

White: a person having origins in any of the original peoples of Europe, North Africa, or the Middle East

References

List two adults, other than your pastor or immediate family members, whom you will ask to provide personal references for you. You might consider your Sunday school or school teacher, neighbor, youth group sponsor, mentor, and employer.

First Reference

Name:

Street Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Second Reference

Name:

Street Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Student's Commitment

I understand that as a student at Bethany Christian High School, I will be expected to follow Christian standards. I commit myself to follow school rules, to respect others, take care of school property, and abstain from the use of tobacco, alcoholic beverages, and illegal drugs. Not only will I abide by these lifestyle expectations, but I will seek to contribute to a wholesome Christian atmosphere.

Parents’/Guardians’ Commitment

As parents/guardians we understand Bethany’s lifestyle expectations and affirm our child’s intention to attend. We commit ourselves to support the school’s policies and to pay school fees on the agreed-upon schedule. We will do all in our ability to support our child and the school.

Disclosure of Student Records and Agreement to above Commitments

By submitting this application parents/guardians and student authorize Bethany to access previous student records and agree to abide by the above Parents'/Guardians' Commitment and Student's Commitents.