West Covina Hills Adventist School

                                New Student Application Form

                                                     20___ - 20___ School Year

 

This form and $50.00 must be submitted for each new student applying for admission.  Important: This “good faith” deposit will be subtracted from your registration fee when completing registration.   It is not refundable.

 

 

Student’s Legal Name

________________________________________________________________

             first                                middle                          last

 

Grade____ Age____                                           Birthdate ____/____/____

                                                                                

                                                                                                                                                                                                                                                                                        

Parents’ Names ________________________________________________________________________

 

Address ___________________________________________Home Phone _________________

 

_________________________________________________________________________ ______ Other phone ____________________________

 

Family Church Affiliation ________________________________________________    

                                        (denomination and specific home church)

Check one:   __ Active Member          __ Attend Periodically   __ Affiliation only   

                                                                                                                    

 Reason for applying to West Covina Hills Adventist School:

___________________________________________________________________________________________________________

 

___________________________________________________________________________________________________________

 

___________________________________________________________________________________________________________

 

Last school attended: ________________________________________________________________________________

 

(mailing address)  ______________________________________________________________________________________

 

References: (List 3 non-family individuals who know the student well.  Last teacher must be included if applicable.)

 

Name         ____________________________       ____________________________          ____________________________

 

Address      ____________________________       ____________________________           ____________________________

 

                       ____________________________        ____________________________          ____________________________

 

Phone          ____________________________        ____________________________          ____________________________

Relationship to

Student       ____________________________        ____________________________          ____________________________

 

 

For Admissions Committee Use

 

 

 

 

 

 

 

 

West Covina Hills Adventist School      3528 East Temple Way      West Covina, CA 91791    626.859.5005