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Basic Information
Last Name*
First name*
Middle Name
Preferred Name
Address
Street Address*
City*
State*
Zip Code*
Contact Information
Email Address*
Home Telephone (xxx-xxx-xxxx)*
Additional Information
Date of Birth (mm/dd/yy)*
Place of Birth*
Age
Male/Female

SSN (xxx-xx-xxxx)*
Citizenship*
SDA Baptized?

Baptized Where?
Grade Applying For
Pre-Kindergarten
Grade
Please list information regarding school last attended if other than TAA:
Grade Attended
Name of School
School Address
Years Attended
Father/Guardian Information
Full Name of Father/Guardian*
Father's Date of Birth (mm/dd/yy)*
Father's SSN*
Father's Email
Father's Facebook
Father's Home Address*
Father's City/State/Zip Code*
Father's Home Phone (xxx-xxx-xxxx)*
Father's Cell Phone (xxx-xxx-xxxx)*
Additional Father's Info
Father's Employer
Father's Occupation
Father's Work Address
Father's Work Phone*
Father's Highest Education Completed
Father's One Call Preferred # (xxx-xxx-xxxx)
Father's Church Affiliation
Father's Home Church
Father Baptized?

Mother/Guardian Information
Full Name of Mother/Guardian*
Mother's Date of Birth (mm/dd/yy)*
Mother's SSN*
Mother's Email
Mother's Facebook
Mother's Home Address*
Mother's City/State/Zip Code*
Mother's Home Phone (xxx-xxx-xxxx)*
Mother's Cell Phone (xxx-xxx-xxxx)*
Additional Mother's Info
Mother's Employer
Mother's Occupation
Mother's Work Address
Mother's Work Phone*
Mother's Highest Education Completed
Mother's One Call Preferred # (xxx-xxx-xxxx)
Mother's Church Affiliation
Mother's Home Church
Mother Baptized?

Marital Information
Marital Status




Custody


Medical
General Health of Applicant
Physical Limitations
Doctor's Name
Doctor's Phone
Emergency Contact
Emergency Contact Name
Who to contact in case of emergency (if parents cannot be reached):
Relationship
Emergency Home Phone
Emergency Cell Phone
Has The Applicant Ever
Had any psychological test and/or counseling?

If yes, please explain
Been "double promoted?

If yes, which grades were skipped?
Repeated a grade?

If yes, which grades were repeated?
Been suspended or dismissed from school?

If yes, what was the reason for the suspension?
Been in advanced, accelerated, or honors classes?

If yes, which classes/subjects?
Had any clinically diagnosed learning disabilities?

If yes, what was diagnosed?
Had any special additional testing or tutoring?

If yes, what special testing or tutoring have you done?




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