Middle School Application Form
In addition to filling out this online application, you will also need to submit the items listed on
the application process page
.
Beginning Semester:
*
1
2
Applying for Grade:
*
select...
6
7
8
Year:
*
select...
2007-2008
2008-2009
2009-2010
2010-2011
Student
Middle Name:
First Name:
*
Last Name:
*
Street address:
*
City:
*
State:
*
Postal Code:
*
ZIP/Postal Code
Social Security Number:
Birth Date
*
month
January
February
March
April
May
June
July
August
September
October
November
December
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Please select the ethnic group you identify with:
select...
1. Native American
2. African-American
3. Asian
4. Hispanic
5. Caucasian
6. Multiracial
7. Other (write below)
used for state-required reports
Other ethnic group (instead of above):
School
(to be completed by parent/guardian)
School last attended:
*
Phone:
*
Current School District:
Has your child received assistance for any special learning needs in the past?:
Yes
No
If yes, please describe briefly the nature of the assistance:
Parents/Guardians
Father
First Name:
Middle Name:
Last Name:
BCS Alum?:
select...
Not a BCS Alum
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
Select graduating year if you are a BCS alum
Address:
Email:
Home Phone:
Work Phone:
Cell Phone:
Job Title:
Employer:
Mother
First Name:
Middle Name:
Last Name:
BCS Alum?:
select...
Not a BCS Alum
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
Select graduating year if you are a BCS alum
Address:
Email:
Home Phone:
Work Phone:
Cell Phone:
Job Title:
Employer:
Guardian
If the student lives with a guardian other than either parent, please complete the following:
First Name:
Middle Name:
Last Name:
BCS Alum?:
select...
Not a BCS Alum
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
Select graduating year if you are a BCS alum
Address:
Email:
Home Phone:
Work Phone:
Cell Phone:
Job Title:
Employer:
Family
1st Sibling
Click the links below to add additional siblings
Grade:
Name:
2nd Sibling
Name:
Grade:
3rd Sibling
Name:
Grade:
4th Sibling
Name:
Grade:
Maternal Grandparents
Name:
Phone:
Address:
Paternal Grandparents
Name:
Phone:
Address:
Christian 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 High School?:
What goals do you hope to reach as a Bethany student, and how do you plan to reach those goals?:
Interests
In which of the following activities would you like to participate at Bethany? Check as many areas as you wish.
Athletics:
Basketball
Intramurals
Soccer
Volleyball (girls)
Music and Drama:
Orchestra
Private Lessons in Voice
Private Lessons in Instrument
Drama/Musical
If you select Orchestra please enter your instrument in the space below
Instrument:
Student Leadership:
Activity Committees
School Paper
Yearbook
How did you hear about Bethany?:
Family member or friends
Church/pastor
Former/current student
Bethany teacher
Visitors’ Day
Billboard ad
Radio ad
Newspaper ad
Bethany web site
Mailing from Bethany
Check items listed that were influential in your decision to consider enrolling at Bethany Christian Schools.
Please list the individuals who have been influential in your decision to attend Bethany:
You may also include any other influences not listed above
References
List two adults, other than your pastor, 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:
City:
Street Address:
State:
Postal Code:
Phone:
Second Reference
Name:
Street Address:
City:
State:
Postal Code:
Phone:
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.
Spam Blocker:
*
This question filters out spammers
