STUDENT INFORMATION

Name

First Name

Last Name

Name you like to be called

When do you plan on attending Laurelbrook?

Grade you will be entering at Laurelbrook?

Current Age

Can you speak English?

Can you write in English

Contact Information

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent or Guardian Phone

Please provide your full phone number. International applicants please include your country code.

Did anyone refer you to Laurelbrook, if yes, who?

VITAL STATISTICS

Date of birth (month first)

YYYY

Gender

Race

Birthplace

Citizenship

Social Security Number

RELIGIOUS BACKGROUND

Religious affiliation

How long have you been a member of your religious group?

Do you attend church regularly?

Home church

Have you been baptized?

Date of baptism

YYYY

FAMILY DATA

ANSWER THE QUESTIONS THAT FOLLOW, THEN FILL OUT A "PARENT OR GUARDIAN" SECTION FOR EACH PARENT OR GUARDIAN IN YOUR FAMILY (FATHER, MOTHER, STEPFATHER, STEPFATHER, OR OTHER GUARDIAN). LEAVE ANY REMAINING "PARENT OR GUARDIAN" SECTIONS BLANK.

Parental marital status

Are your parents in favor of you attending Laurelbrook Academy?

PARENT OR GUARDIAN 1

Name

First Name

Last Name

Relationship to Student

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Religious affiliation

Highest level of eduction completed

Home Phone

Country

(###)

###

####

Work Phone

Country

(###)

###

####

Mobile Phone

Country

(###)

###

####

Do you live with this individual?

Is this individual your legal guardian?

Which of the following should be sent to this individual?

PARENT OR GUARDIAN 2

Name

First Name

Last Name

Relationship to Student

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Religious affiliation

Highest level of education completed

Home Phone

Country

(###)

###

####

Work Phone

Country

(###)

###

####

Mobile Phone

Country

(###)

###

####

Do you live with this individual?

Is this individual your legal guardian?

Which of the following should be sent to this individual?

ACADEMIC INFORMATION

Evaluate your scholastic interest

What subjects of study do you enjoy most? Why?

How much formal education do you intend to complete?

What are your career goals?

Have you ever been homeschooled?

If "Yes", which grades?

Have you ever been kicked out of school?

If "Yes", why?

ACADEMIC HISTORY

LIST ALL THE SCHOOLS YOU HAVE ATTENDED, INCLUDING CORRESPONDENCE SCHOOLS, BEGINNING WITH THE EIGHTH GRADE. LIST THE SCHOOL NAME, ADDRESS, DATES OF ATTENDANCE, CLASSES TAKEN, AND GRADES RECEIVED.

Eighth Grade

Ninth Grade

Tenth Grade

Eleventh Grade

Twelfth Grade

LEARNING & EMOTIONAL INFO

Have you ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?

Have you ever been treated for emotional or behavioral difficulties or an eating disorder?

During the past 12 months, have you seen a professional to address mental/emotional health concerns?

Have you had a significant life event that continues to affect your life (History of abuse, death of a loved one, family change, adoption, foster care, new sibling, survived a disaster, others)?

Please explain "Yes" answers in the space below. We may contact you for additional information.

STUDENT CONTRACT

TO BE COMPLETED BY THE APPLICANT.

My desire is to cooperate fully with the staff in all aspects of the educational program at Laurelbrook Academy. I will abide by the rules of the school and will, by my conduct and attitude, do my utmost to help others to have a superior learning and spiritual growth experience while at school. I have read the handbook and I understand and subscribe to the rules and regulations therein.

PARENT OR GUARDIAN CONTRACT

TO BE COMPLETED BY THE PARENT OR GUARDIAN OF THE APPLICANT.

I have read the information contained in this application, and, to the best of my knowledge, agree that the answers given are correct. I am in harmony with the conditions, principles, and regulations, in the current Laurelbrook Academy handbook, and understand also that additional duly considered regulations as published or announced by the administration during the school year will have the same force as those printed, and will do my best to cooperate in seeing that they are carried out. By registering my child at Laurelbrook Academy I recognize that he or she will be participating in a manual arts program for approximately four hours each day. This vocational training program earns academic credit for the experience and a scholarship according to the grade earned.

ADDITIONAL PARENTS OR GUARDIANS

If you have additional parents or guardians, please enter their information below.

SPIRITUAL INTEREST

Evaluate your spiritual interest

Do you have a personal experience with Jesus Christ? If so, explain how you know this for a fact. If not, tell why you want to attend a Christian school.

Do you take time for personal devotions?

Describe your confidence in the Bible and Spirit of Prophecy as a guide for daily living.

Name any Spirit of Prophecy books you have read.

In which areas of life do you feel you will need the most counsel or help?

MUSICAL INTEREST

Do you enjoy singing?

What part do you sing

Name any instruments you play.

MEDIA & HOBBIES

What are your favorite books?

What sorts of movies do you watch? What sorts of movies do you avoid? Why?

What do you like to do in your spare time?

WORK ETHIC

Do you enjoy outdoor work?

Do you enjoy household duties?

How do you feel about spending half of your daily education in active vocational training?

Do you have any major medical issues we should be aware of? If so, explain.

INTEREST IN LAURELBROOK

What are the main reasons you want to attend Laurelbrook next year rather than other Christian schools?

Why should YOU be one of the students we accept at Laurelbrook Academy?

SHORT RESPONSES

RESPOND IN ONE OR TWO SENTENCES WHAT THESE STATEMENTS MEAN TO YOU, REGARDING EACH OF THE FOLLOWING UNIQUE ASPECTS OF LAURELBROOK LISTED BELOW.

Our unique educational program seeks to reach God's higher standard scholastically

Competition will be eliminated as far as possible from the classroom.

There will be no program of competitive sports.

Boys and girls are expected to dress in modest and healthful apparel.

In all manner of apparel, grooming, hairstyle, etc. there should be a plain distinction between men and women.

There is no dating allowed, nor any special attachments to individuals on or off campus.

Students encouraged to take time each day for personal devotions with God.

STATEMENTS OF HONESTY AND ACCURACY

STUDENT

I have read the information contained in this questionnaire, and, to the best of my knowledge, agree that the answers given are correct.

PARENT OR GUARDIAN

I have read the information contained in this questionnaire, and, to the best of my knowledge, agree that the answers given are correct.

Comments

Student Application