Charleston Seventh-day Adventist School

New Application

New Application
Charleston SDA School
2518 Savannah Highway
 Charleston, SC 49414
Please share with us
How did you hear about Charleston SDA School? (Please circle one):
Current Charleston SDA School family              Drive-by             Friend             Advertisement
Other: ____________________________________________________________________________
Student Name and Family Information
I am applying for ____ grade, beginning   Fall ____ Winter ____   of 20 ___
Applicant’s Name: ________________________________________________________________
                                           First                                 Middle Initial                                 Last                                                        
Goes by: _______________________________    Male _____         Female _____
Social Security #: ________________________    Date of Birth:   _____________
(Make SS Card, birth certificate, & immunization available for copying)  Place of Birth _____________
Father’s Name: __________________________    Mother’s Name: _________________________
                                         First                       Last                                                                              First                        Last
Street Address: _____________________________________________________________________
City: __________________________      State: __________________     Zip: ___________________
Home Phone: ___________________________ Email ___________________________________
Father’s Occupation: ______________   Business Phone: __________ Cell Phone: ____________
Years of Education ___________ Birth Place __________________ Birth Date _______________
US Citizen? ____ Marital Status ________SS# _____________other Email _________________
Mother’s Occupation: _____________ Business Phone: __________ Cell Phone: ____________
Years of Education ___________ Birth Place __________________ Birth Date _______________
US Citizen? ____ Marital Status ________SS# _____________other Email _________________
Check if appropriate:
_____ Father deceased _____ Mother deceased _____ Parents divorced
_____ Parents separated _____ Father remarried _____ Mother remarried
Please list child’s secondary household:
Name: ______________________________________ Relation: _______________
                                First                                       Last
Street Address: ____________________________________________________________________________
City: ___________________________ State: ___________________ Zip: _____________________
Home Phone: ____________________ Email ___________________________________________
Occupation: _____________________ Business Phone: ___________ Cell Phone: ______________
Church Affiliation
Name of Church _______________________________ Years Attended: ______
Pastor’s Name _____________________________                   Phone Number ________________
Do you and your child actively attend church regularly?    Yes _____ No _____
Is applicant an Adventist Church Member?         Yes ___ No ___      
Father a member? Yes ___ No ___ Mother a member? Yes ___ No ___
Education Information
Present School _______________________________        Dates Enrolled: ____________________
Phone Number: _______________________________
Present Teacher _______________________________
Has applicant ever skipped a grade? _______________
Has applicant ever been retained? _________________
Has applicant ever been suspended or expelled form school for any reason? ___________________
If yes on any questions above, please explain: ___________________________________________
If the applicant has a disability and would like to request accommodations in the admission process, please explain here. Documents from a qualified professional should either be enclosed with this application or sent directly to the school office: ___________________________________________
Does the applicant require any medication? _____________ If yes please explain: _______________
Check here _____ I understand a current physical exam will be submitted to complete registration.
Parent Testimony
Please give a brief description of your faith in Christ, when you came to know the Lord, evidences of your spiritual growth, etc:
Please give a brief summary of your expectation of Christian education, to include your reasons for applying your child in Charleston SDA School:
Application must be complete and received with appropriate fees in order be processed. A completed application does not guarantee acceptance. The CSDAS School Committee makes final decisions.