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: * select...456789101112

Beginning Semester: *

1

2

School Year: *

Student

First Name (Legal): *

First Name (Preferred):

Nickname or name student prefers to be called

Middle Name:

Last Name: *

Street Address: *

City: *

State: *

U.S. County of Residence:

Postal Code: *

ZIP/Postal Code

Gender: * select...FM

Birth Date*

monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

day12345678910111213141516171819202122232425262728293031

Email:

Home Phone: *

Cell Phone:

School

(to be completed by parent/guardian)

School last attended: *

Phone: *

Current School Corporation:

Is the applicant able to meet essential performance requirements of Bethany, either with or without reasonable accommodations?: *

Yes

No

If no, describe briefly the nature of the assistance needed (optional):

Family

Father/Male Guardian

First Name:

Middle Name:

Last Name:

Relationship: select...ParentGuardianStepparentOther

Street Address:

State:

City:

ZIP/Postal Code:

Home Phone:

Work Phone:

Cell Phone:

Work Email:

Home Email:

Employer:

Job Title:

BCS Alum?: select...Not a BCS Alum20052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956

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...Not a BCS Alum20052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956

Select graduating year if you are a BCS alum

Paternal Grandparents

Grandfather's Last Name:

Grandfather's First Name:

Grandfather BCS Alum: select...Not a BCS Alum200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955

Grandmother's Last Name:

Grandmother's First Name:

Grandmother BCS Alum: select...Not a BCS Alum200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955

Street Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Maternal Grandparents

Grandfather's Last Name:

Grandfather's First Name:

Grandfather BCS Alum: select...Not a BCS Alum200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955

Grandmother's Last Name:

Grandmother's First Name:

Grandmother BCS Alum: select...Not a BCS Alum200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955

Street Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Siblings

1st Sibling

Click the links below to add additional siblings

Name:

Birth date

monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

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Current School:

Grade Level: select...Pre-KK123456789101112HS Grad

2nd Sibling

Name:

Birth date

monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

day12345678910111213141516171819202122232425262728293031

Current School:

Grade Level:

3rd Sibling

Name:

Birth date

monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

day12345678910111213141516171819202122232425262728293031

Current School:

Grade Level:

4th Sibling

Name:

Birth date

monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

day12345678910111213141516171819202122232425262728293031

Current School:

Grade Level:

Personal Faith and Interests

Place of worship:

Denomination/Faith Group:

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?:

What characteristics of Bethany interest your family and why is Bethany a good match for you?:

List your interests and awards—in and out of school—related to academics, arts, sports, church, community service, clubs, etc.:

Interests

In which of the following activities would you like to participate at Bethany? (•middle school only; *high school only)

Athletics:

Volleyball (girls)

Cross Country

Soccer

Basketball

Cheerleading*

Softball* or Basebal

Tennis

Track

Intramurals

Music and Drama:

Choir

Orchestra

Bruin Jazz*

Private Lessons in Voice

Private Lessons in Instrument

Drama

Musical*

Handbells•

If you select Orchestra or Jazz Band, please enter your instrument in the space below

Instrument (list musical instrument you play or are interested in playing):

Academic and Student Leadership:

Academic Superbowl*

Chapel Committee*

Chess Club

Speech and Debate*

Student Government

School Paper

Yearbook

Photography

Student Authorization: *

Applicant agrees

I affirm that the information provided in the application is accurate to the best of my knowledge.

Parent/Guardian Authorization: *

We agree (all parents/guardians)

We affirm that the information provided in the application is accurate to the best of our knowledge.

Information Release: *

Parent/Guardian authorizes

I authorize the designated representative of the applicant's current/most recent school to release information for the applicant to Bethany Christian Schools for admissions purposes.

Non-descrimination statement

Bethany Christian Schools admits qualified students of any race, color, and national or ethnic origin.