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.