BCS Main

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: *

Applying for Grade: *

Year: *

Student

Middle Name:

First Name: *

Last Name: *

Street address: *

City: *

State: *

Postal Code: *

ZIP/Postal Code

Social Security Number:

Birth Date*

Please select the ethnic group you identify with:

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

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

Parents/Guardians

Father

First Name:

Middle Name:

Last Name:

BCS Alum?:

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 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 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?:

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.

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Middle School Application Form