Ignite Christian Academy Student Application

Student Application

Student's Full Name

Birthday

Month

Day

Year

Age

Gender

Male

Female

Mother's Name

Mailing Address

Phone

Do you attend church?

How often?

Church Name and Pastor

Occupation

Employer

Father's Name

Mailing Address

Phone

Do you attend church?

How often?

Church Name and Pastor

Occupation

Employer

Student Academic History

Current School

Current Grade

Years Attended

Has the applicant ever been suspended, expelled, or on probation from school? If yes, explain...

Has the applicant ever moved ahead a grade or had to repeat? If yes, explain...

Has the applicant had any scholastic difficulties in school? If yes, please explain...

Does the applicant have any special learning needs?* If yes explain...

Why would you like your child to attend Ignite Christian Academy?

How did you hear about Ignite Christian Academy?

Date

Month

Day

Year

Signature

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Ignite Christian Academy

Student Release of Records

Date

To Whom It May Concern,

Subject: Request for Release of Student Records

Ignite Christian Academy is requesting the release of official student records for the following student who has enrolled at our institution:

Student Name

Date of Birth

Grade Level

Previous School

Please forward the following records to our office:

· Official transcript/academic records

· Standardized test scores

· Attendance records

· Health and immunization records

· Disciplinary records (if applicable)

· Special education records (IEP/504, if applicable)

Send records to:

Ignite Christian Academy

488 Industrial Rd. A

Grove, OK 74344

Email: admin@lwcaok.org

Phone: 918-314-7817

This request is in compliance with the Family Educational Rights and Privacy Act (FERPA), which permits the release of student records to another school in which the student is enrolled or intends to enroll.

Parent/Guardian Authorization

I hereby authorize the release of all educational records for the student named above to Ignite Christian Academy.

Signature

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Ignite Christian Academy

Enrollment Verification Number

The parent or legal guardian must request an Enrollment Verification Number (EVN) for each student from the school their student(s) attends or plans to attend to apply for the Oklahoma Parental Choice Tax Credit. Ignite Christian Academy will submit the following information on the EVN form to the Oklahoma Tax Commission in order for you to obtain a unique EVN for your student. Once you receive the number, you can then apply for the Oklahoma Parental Choice Tax Credit. Visit the Oklahoma Tax Commission website for more details on the Oklahoma Parental Choice Tax Credit.

Student Information

Student Name and Middle Initial

Birthday

Month

Day

Year

List any scholarships the student has received.

Parent Information

Primary Parent | Guardian Information

Only the primary parent will receive email notifications from the state concerning the EVN number.

Name with Middle Initial

Multi-line address

Country/Region

Address

City

Zip / Postal code

Secondary Parent | Guardian

Name with Middle Initial

Multi-line address

Country/Region

Address

City

Zip / Postal code