Naperville Christian Academy
Application for Admission
for New Students from Current Families
2013-2014
Application Checklist
Application
Birth Certificate (copy)
Application Fee $250 per student (non-refundable)
Transcripts (for Grades 1-12)
Classroom Teacher Evaluation Form
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$325 per student if application postmarked on or before February 26, 2013
$400 per student if application postmarked after February 26, 2013
($200 of Application Fee is a tuition deposit, which is refundable if student is not enrolled)
$100 Testing Fee due at time of testing (K-12 only)
Please carefully read the application and PRINT all requested information.
Note that children must be 5 years old no later than September 1, 2013 to apply for Kindergarten.
General Information
Student’s Full Name
______________________
Last
First
Middle
Preferred Name
Home Address
_____________________
Number and Street
Home Phone
State
Zip Code
Cellular Phone
Date of Birth
If Kindergarten _____AM
City
Gender
_____Full Day
Applying for Grade
If Preschool: ____3 Day ____5 Day,
____AM ____PM
School Information
Present School
_______________________
Address
________________________
Grades attended
_______________________
Please list other schools your child has attended.
School
Grades attended
School
Grades attended
School
Grades attended
For Office Use Only
Application received. Date:
Application Fee received
Birth Certificate received
Parental Pledge signed
Transcripts received
Classroom Teacher Evaluation received
Admission Testing Scheduled. Date:
Parent Interview Scheduled. Date:
 Parents notified of admissions decision.
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Student Information
Please use reverse or another sheet if necessary.
1.
Are you applying for your child’s first school experience?
List preschool(s), if any.
Yes or No
2.
Has your child ever skipped a grade?
If yes, what grade?
Yes or No
3.
Has your child ever repeated a grade ?
If yes, what grade?
Yes or No
4.
Has your child been referred for or given diagnostic testing?
If yes, what tests were recommended or administered?
Yes or No
5.
Has your child ever been recommended for or participated in a gifted program?
Yes
or No
If yes, please briefly describe program.
6.
Has your child ever received special help or tutoring?
If so, please indicate the grade(s), subject(s), and circumstances.
Yes or No
7.
Has your child ever been diagnosed with ADD or ADHD?
Yes
or No
8.
Has your child ever been diagnosed with or shown signs of dyslexia?
Yes
or No
9.
Does your child have any allergies?
If so, please elaborate.
Yes
or No
Yes
or No
10. Does your child regularly require medication?
If yes, explain.
11. Has your child ever seen a counselor or doctor for any type of behavioral or
mental problems?
Yes or No
If yes, explain.
12. Does your child have any record of school disciplinary problems?
If yes, explain.
Yes
or No
13. Has your child ever been dismissed or suspended from any school?
If yes, describe briefly the nature of the situation.
Yes
or No
14. Has your child ever been involved in legal problems or been arrested?
If yes, explain.
Yes or No
15. Is your child presently experiencing any situations unique to your family or home life that the school should know about, so
as to better understand him/her and provide support where needed?
16. Please describe the strengths and weaknesses of your child, and how these traits affect his or her learning style or behavior.
17. What are your child’s special interests or extra curricular activities?
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Classroom Teacher Evaluation
(Applicants for Kindergarten and Grade 1)
Parent Instructions:
Please complete the top portion and give this form to your child’s current teacher. The teacher must return the form
to NCA for your child’s application to be complete.
Name of Applicant:
Applying for Grade
My son/daughter is applying for admission to Naperville Christian Academy. Please complete this form and mail it to the Admissions
Director at NCA. I authorize the release of my child’s records and evaluative data to NCA and hold you harmless for information
provided.
Signature of Parent/Guardian
Date
Current Teachers:
Naperville Christian Academy appreciates an honest assessment of the above named student. All information will be kept confidential,
will not be shared, nor will it become a part of the applicant’s permanent record.
Teacher:
Subject(s):
Grade:
School:
Teacher’s Signature :
Date:
Excellent
Good
Average
Needs
Improvement
Separates easily from parents
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Follows directions
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Self confidence
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Ability to communicate clearly
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SOCIAL/EMOTIONAL
Emotional maturity
Attitude towards peers
Attitude of peers toward student
Attitude towards authority
Willingness to obey
Ability to work independently
Classroom Teacher Evaluation p. 1
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SCHOOL PERFORMANCE
Excellent
Good
Average
Needs
Improvement
Small motor coordination
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Number recognition
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Counting skills
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Math skills
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Large motor coordination
Conversational skills
Neatness/Organization
Please comment on the following:
How would you describe this child’s temperament?
Parental support and involvement:
Has outside help been recommended?
Please elaborate:
□ Yes □ No Been given? □ Yes □ No
Applicant’s social and emotional development compared with others:
Describe student’s response to direction and/or correction:
Special needs:
Strengths and weaknesses:
Please include additional comments:
Thank you for your time. Please mail this to:
Naperville Christian Academy, Attn: Admissions, 1451 Raymond Drive, Suite 200, Naperville, IL 60563
Classroom Teacher Evaluation p. 2
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