Countryside Christian School - Request Information

Thank you for your interest in Countryside Christian School!

Please fill out the form below and our Admissions Office will contact you and provide the information you desire.

Parent / Guardian Information
First Parent / Guardian First Name * Middle Name Last Name * Salutation * Email Address * Confirm Email Address * Gender * Cell Phone *	Second Parent / Guardian (leave blank if not applicable) First Name * Middle Name Last Name * Salutation * Email Address * Confirm Email Address * Gender * Cell Phone *

Home Address
Street Address * City * Country * State * Zip * Home Phone * How Did You Hear About Us? * Details: Why are you interested in Countryside for your child's education? * Do you currently attend church? * Yes No If you answered no, would you be willing to join a local church should your student(s) be accepted? Yes No Name of church attending: * How long have you been attending? * How often do you attend? * Weekly Monthly Seldom Pastor's Name: * Church reference name and contact information: * What are your spiritual goals for your child? * How do you anticipate Countryside Christian School will facilitate the achievement of these goals? * Do you have other children who are not applying? * Yes No If yes, please list the grades: Infant PK2 PK3 PK4 Kindergarten 1st-3rd 4th-5th 6th-8th 9th-12th Reason(s) they are not applying: * Do you or your child have any relatives or acquaintances our school? Yes No Please list their name: Student 1 First Name * Middle Name Last Name * Birthdate * (mm/dd/yyyy) Gender * Grade Level of Interest * School Year * Current School * Reason for transferring: * Please indicate which program your child is applying for: * Has your child attended daycare/preschool before? * Yes No Are you looking for full or part-time care? * Full-time (5 days/week) Part time (5 Half days/week) Part-time (2 or 3 days/week) Are you interested in or have you applied for the Step Up Scholarship (not applicable for Preschool)? * Yes No Is your child currently on scholarship? * Yes No Please indicate which scholarship. * To help us better understand each student’s academic progress, we request that a copy of the following documents be submitted before completing the application. Reviewing these documents allows our team to evaluate the student’s current academic standing and determine whether our program is an appropriate fit to support their learning needs. This step helps ensure we can provide the appropriate academic environment prior to moving forward with the admissions process. Requested Documents: -Recent Report Card -Recent Standardized Test Scores -High School Transcript Click here to upload. * Documents have been uploaded No documents uploaded Does the student presently have a 504 or IEP? If yes, please upload your student's IEP/504 Here. * Yes No Has your student ever been retained? Yes No If yes, please explain. Please explain any academic or medical problems your student may be experiencing: Were there any problems with teacher or administration at previous school? * Yes No Please explain: * Has student ever had disciplinary difficulties or been expelled, dismissed, suspended, or refused admission in another school? * Yes No Has your student ever had a referral? * Yes No Is There Another Student? Yes No Please wait Parent / Guardian Notes *