Application - Cornerstone Academy

Student Information

Please fill in the following fields about the student as thoroughly as possible.

Student First Name

Student Last Name

Student Address

Address Line 1

Address Line 2

City

State

Zip Code

Student Date of Birth

Gender

Applying for…

Religious Affiliation

Please fill in the following fields about the student's Religious Affiliation.

Do you attend church on a regular basis?

Yes

No

Local Congregation

What expectations do you have for the education of your child at CA?

Which grade is your child applying for?

K

1-5

Please provide any additional information that may assist us in the admissions process.

Household

Address

Address Line 1

Address Line 2

City

State

Zip Code

Does the applicant have any siblings?

Yes

No

Siblings

Sibling Name	Age	Gender

Medical Information

Insurance Company

Does the applicant have any allergies?

Yes

No

Please Explain

Explain the results of any testing for learning disabilities or ADD/ADHD. If curriculum modification has been necessary or may be desirable in the future for the applicant, please explain.

Is the applicant up to date on immunizations recommended by the state of MN?

Yes

No

If not, what sort of exemption will the applicant be submitting?

Alumni or Currently Enrolled Students

Does the applicant have any other relatives who currently attend, have attended or have graduated from our school?

Yes

No

How did you hear about us?

Parent Acknowledgement

We/I agree that Cornerstone Academy will hold the applying family to be:

Solely responsible for all financial obligations incurred by the applying child.
In agreement with and supportive of CA’s statements of philosophy, mission and standards.
Forthright and truthful in all information given in this application.

First Name

Last Name

Today's Date