Student First Name: Student Middle Name: Student Last Name: Student suffix: Student Date of Birth (mm/dd/yyyy): Applying for (grade level): APPLICATION FOR ADMISSION Please complete the application form with information entered accurately and completely. The information gathered from this application will be used to generate the I-20 Form should the student be accepted. Therefore, accurate information is essential. If you have any questions regarding your application please feel free to contact Kathi Johnson at (864)578-4238 or kjohnson@fbns.org. Student Nickname: Student Home Phone: (ex. 999-999-9999) Student Cell Phone: (ex. 999-999-9999) Student Email Address: How did you hear about us? Student Address Street Address: City: State: A Ministry of First Baptist North Spartanburg 8740 Asheville Highway, Spartanburg, South Carolina 29316 Phone (864) 578-4238 Fax (864) 542-1846 www.scawarriors.org Students are well educated, equipped with a biblical worldview and exhibit a heart for Christ.
Zip: Country: Student Gender o Male o Female Birth City: Birth Country: Please enter your full legal name as it appears on your passport or birth certificate: Please enter your birthday as the day upon which you were born. Please include the month/day/year you were born: Please specify your citizenship: Ethnicity o Caucasian o African o Latin American o Hispanic o Asian o Indian o Other If other, please list: Passport number: Place of Issuance: Date of Issuance (mm/dd/yyyy): Date of Expiration (mm/dd/yyyy): Are you interested in living with a homestay family? If no, whom do you intend to live with while enrolled at SCA? Please indicate student s T-shirt size:
Check any activity in which you are interested. Please note: Athletic eligibility or participation is not guaranteed. Athletic Activities o American football o Bowling o Soccer o Baseball/softball o Cross country o Track o Tennis o Cheerleading o Basketball o Golf o Volleyball Outdoor Activities: o Backpacking, hiking o Fishing o Sailing/boating o Biking o Raising animals o Swimming o Camping o Riding horses Indoor Activities: o Arts & crafts o Movies o Sewing o Writing o Baking o Museums o Shopping o Cooking o Reading o Watching TV Other Activities: o Community service o Photography o Travel o Singing o Family activities o School activities o Woodworking o Music o Table games o Playing an instrument
Do you play in a band or orchestra? If yes, which instrument(s)? Do you have any pets? If yes, what are they? Would you be willing to live with a homestay family that has pets living in the home? List the household tasks for which you are responsible at home. Would you be willing to contribute to the life of your homestay family by taking part in household tasks? Please complete the following questions for previously attended schools, including Homeschool. You must submit a transcript of courses you have completed during the last three years and the grade you have reached to Kathi Johnson at kjohnson@fbns.org (if your original transcript is not in English, it must be translated to English and the American grading system.) Most Recent/Previous School Attended: School Name Address: City: State: From Date: To Date: Grade Completed: Have you previously attended any other school? Second Most Recent/Previous School Attended School Name: Address:
City: State: From Date: To Date: Grade Completed: Country: Have you ever repeated a grade? Has the student ever been referred for or enrolled in speech therapy, occupational therapy, or had intervention as a result of developmental or academic evaluation, or received tutoring? Has the student ever been diagnosed with a learning disability, ADHD, dyslexia, anxiety, emotional, or physical disability that impacts academic success? (A copy of the educational testing, 504 plan, or IEP must be turned in prior to the interview.) Have you ever received counseling? Have you ever been suspended, dismissed, or denied re-enrollment at any school or program for academic, disciplinary, or other reasons?
Have you ever used illegal drugs, alcohol, or tobacco? Native Language: Do you speak any additional languages? If yes, please list each additional language spoken with the number of years each language has been studied. Is there anything else you would like us to know about you? Parent Information Home address Street address: City: State: Country: Home phone (ex. 999-999-9999): Parent/Guardian One Last Name: First Name: Middle Name: Suffix: Gender: o Male o Female Relationship to Applicant: Parent/Guardian Two Last Name: First Name: Middle Name: Suffix: Gender Male Female Relationship to Applicant:
Custodial Rights: Custodial Rights: Yes No Financial Responsibility: Receive Correspondence: Marital Status: o Married o Divorced o Single o Other Financial Responsibility: Yes No Receive Correspondence: Yes No Marital Status Married Divorced Single Other Email 1: Email 2: Work Phone: Cell Phone: Occupation: Job Title: Employer: Religious Affiliation: Highest Level of Education: Work Phone: Cell Phone: Occupation: Job Title: Employer: Religious Affiliation: Highest Level of Education: Household 2: Does the applicant have a parent/legal guardian that lives at another address?
Medical Information Because SCA cares for the health and safety of your child, please provide the following information. Check yes to give SCA permission to dispense over the counter (OTC) medications to your child. If a student needs to take medication during the school day, that medicine is to be given to the school nurse by an adult in its original container labeled with the student s name, along with instructions and the time the medicine is to be taken. The student is required to submit an official immunization record to the school. This file can be emailed to Kathi Johnson at kjohnson@fbns.org. Blood type: Conditions: Comment: More conditions: Allergies Allergy: Comment: More Allergies: Over the Counter (OTC) Medications Medication: Tylenol Comments:
Ibuprofen (must be 12 or older) Comments: Benadryl Comments: Tums Comments: Cough Drops Comments: Does the student take any medication on a regular basis? If yes, please list the medications and dosages below. Medical History #1: Please check all that the student has ever been diagnosed with or received treatment or attention for: o Altitude Sickness o Allergies o Appendicitis o Asthma o Autoimmune diseases o Brain or nervous system problems o Cancer o Communicable diseases o Depression o Diabetes o Eating disorders o Epilepsy o Eye or vision trouble o Hearing loss o Heart disease o Hernia o Hypertension o Malaria o Menstrual disorders
o Mental or emotional disorders o Pneumonia o Rheumatic Fever o Scarlet Fever o Fevers o Serious headaches or migraines o Serious or persistent cough o Stomach problems o Tonsils, nodes, or throat problems o Typhoid Fever o Urinary tract infections o Vertigo/dizziness o Other ne of the above If you checked Other, please explain: For all of the items checked above, please specify treatments, the disorder s nature and severity, the frequency of attacks, the duration of the disorder, and any other facts that need to be known by school personnel. Medical History #2: Has the student o Had any surgical operation not covered above? o Been hospitalized? o Taken prescribed medication in the past six months? o Used heroin, cocaine, or marijuana? o Used other street drugs? o Received treatment for an alcohol related problem? o Received treatment for a drug related problem? o Had excessive weight gain or loss recently? o Had any dietary restrictions for various reasons? ne of the above. If you checked any of the above questions, please explain: Will the student be bringing any prescribed medication? If yes, please list each medication, including the international and generic names, compound symbols, dosage, frequency, and reason for use. Indicate whether the student has had the following infectious diseases: o Hepatitis A o Hepatitis B o Measles (Rubeola/10-Day Red Measles)
o Mumps o Scarlet Fever o Pertussis (Whooping Cough) o Rubella (German 3-day Measles) o Tuberculosis o Varicella (Chicken Pox) o Other ne of the Above If you checked Other, please explain: If you checked any of the above diseases, please list the date(s) the student had the diseases: Spartanburg Christian Academy requires all first year international students to participate in our Wellness Exam Program. Within the first months of school, students will meet with an interviewer and complete a series of self-assessments to help us determine the student s adjustments, strengths, and weaknesses. The results of this program enable us to better equip our international students for future success. Do you, the parent, give permission for your student to participate in this program? Alumni or Currently Enrolled Students Does this applicant have any family members who currently attend, have studied, or have applied to our school? Student Statement of Agreement We certify that the student will complete the Student Questionnaire completely and honestly. Name: Date:
Student Questionnaire: Have you received Jesus Christ as Savior? If yes, please comment on your faith: Do you want to attend Spartanburg Christian Academy? Why or why not? Are you willing to follow the school s guidelines on dress code and behavior? (If unfamiliar, refer to the SCA Student and Family Handbook) Have you had any serious discipline issues at home or at school? Have you ever tried illegal drugs, alcohol, or tobacco? Have you ever been arrested? Do you have any dietary restrictions? o If yes, please explain (ex. vegetarian, food allergies, diabetic, etc ):yes Are you allergic to any animals? If yes, which animal
Briefly give your reasons for wanting to study at a school in another country. Describe yourself. Tell about an important accomplishment or special interest. Tell about your strengths and weaknesses and likes and dislikes. Describe your family and your home. (Introduce your family members. What are their names, ages, and occupations? What is your home like? Do you have your own room, or do you share your room with others? Where in your house do you study? How far is your home from your school? Do you drive, ride a bus, or a bicycle, or walk to school?) Describe a typical day at school. (How many subjects do you take? What are they? How long are the classes? What is your daily schedule during the school year? Start with when you wake up and discuss only one typical day s schedule.) Describe what you do in your free time. Describe your community. (Is it near a major city? What is the population? Industry? Economy?) Describe your plans and ambitions for your education and career. (Do you want to attend a university? What professional goals do you have?
Describe how you will share your culture with your homestay family and school In order to be consistent with our mission, Spartanburg Christian Academy requires all students to live in a Christian home while attending SCA. Do you understand this requirement and agree to live with a Christian homestay family that is selected and approved by the appropriate school administrators? In order to be consistent with our mission, Spartanburg Christian Academy requires all students to attend a daily Bible class as part of the school curriculum. These courses are required for graduation. Do you understand and agree to comply with this requirement? In order to be consistent with our mission, Spartanburg Christian Academy requires all students to participate in weekly chapel programs. These programs occur once each week as part of the school s curriculum. Additional programs may also be included at various times throughout the school year. Do you understand and agree to comply with this requirement? In order to be consistent with our mission, Spartanburg Christian Academy requires all students to participate in a local church. Students living with homestay families are required to attend church with their homestay family on a consistent basis. Do you understand and agree to comply with this requirement?
Parent Questionnaire The mission of Spartanburg Christian Academy is to serve as partners with Christian parents in providing an excellent education consistent with Biblical truth. Please indicate if one or both parents/guardians have received Jesus Christ as Savior. If yes, please comment on your faith. Describe your child s relationship with you and your family and with his or her friends. (How does your child interact with you and others?) How does he or she respond to disagreements, discipline, frustration, challenges, and difficult situations? Does he or she communicate freely?) Describe your child s personality. (What are his or her interests, strengths, and weaknesses?) Describe your relationship with your child. (How do you communicate love and respect to your child? How much independence do you give your child? What kinds of responsibilities do you give your child? How do your work out differences? How do you enforce rules?) Describe what makes you proud of your child. Explain why you want your child to study abroad. In order to be consistent with our mission, Spartanburg Christian Academy requires all students to live in a Christian home while attending SCA. Do you understand this requirement and agree for your child to live with a Christian homestay family that is selected and approved by the appropriate school administrators?
In order to be consistent with our mission, Spartanburg Christian Academy requires all students attend a daily Bible class as part of the school curriculum. These courses are required for graduation. Do you understand and agree to comply with this requirement? In order to be consistent with our mission, Spartanburg Christian Academy requires all students to participate in weekly chapel programs. These programs occur once each week as part of the school curriculum. Additional programs may also be included at various times throughout the school year. Do you understand and agree to comply with this requirement? In order to be consistent with our mission, Spartanburg Christian Academy requires all students to participate in a local church. Students living with homestay families are required to attend church with their homestay family on a consistent basis. Do you understand and agree to comply with this requirement? In order to be consistent with our mission, Spartanburg Christian Academy requires all students to live in a Christian home while attending SCA. Do you understand this requirement and agree for your child to live with a Christian homestay family that is selected and approved by the appropriate school administrators? How did you learn about SCA?
This document constitutes my authorization and consent for you to provide any and all medical care that you deem necessary or appropriate and in the best interest of my child. A printed copy of this information shall carry the same authority as the original. Consent is being given to release medical background information to those who need to know, such as homestay parents and appropriate school authorities to stand in the place of the parent with legal authority in respect to any decisions regarding this applicant including his health, welfare, education, and travels. Name: Date: If the above student is admitted, I agree to comply with all policies and procedures of Spartanburg Christian Academy as set for in the SCA Student and Family Handbook as well as the International Homestay Program Student Handbook, and I agree to provide payment for all charges as set for in the IHSP Financial Agreement. I acknowledge that all students in grades 8-12 in my family have read and agree to comply with all policies and procedures of Spartanburg Christian Academy as set for in the SCA Student and Family Handbook. Name: Date: