Southern Maryland Christian Academy
General Information Sheet
Welcome to Southern Maryland Christian Academy! We trust that you will find this information helpful as
you consider enrolling your child at SMCA.
ABOUT SMCA
Since 1985, Southern Maryland Christian Academy has kept its conviction to bring strong, biblically-based
Christian education to the Southern Maryland student body. SMCA’s vision is as strong today as it was in their
beginning and it stands resolute to provide its students with the loving, godly education that they deserve.
SMCA has always believed that education should be an extension of the family, and indeed, the school treats
all of its students as though they are family.
ACCREDITATION: SMCA is dually accredited through Association of Christian Schools International
(ACSI) and Middle States Association of College and Schools (MSA).
FACULTY: SMCA employs a qualified and caring teaching staff at every level of education. Each of our
kindergarten through twelfth grade teachers has a bachelor or master’s degree and meets ACSI certification
requirements. Most have taught at SMCA for many years.
CLASSROOM ORGANIZATION: Grades kindergarten through fifth have self-contained classrooms with a
low pupil/teacher ratio emphasizing a strong reading program through a phonics approach. Grades sixth
through
twelfth also have a low pupil/teacher ratio in middle/high school organization focusing on critical thinking
skills and college preparatory skills. Each grade is assigned a homeroom teacher.
Middle school students rotate in quarterly enrichment groups for classes such as Computer, Art, and Spanish.
High school students select electives, including Art, Spanish, Computer Applications, Yearbook, and more, in
addition to the required core classes.
CURRICULUM: We use a broad range of traditional curricula. Our textbook selections are determined by
the administration with input and recommendations from faculty. We use a combination of Christian and
secular publishers. All selections are made with careful consideration of all materials fitting within the
framework of our Christian philosophy of education. Please note a general list of textbooks below.
Preschool (K2-K4)
Bible: A Beka, Positive Action for
Christ
Language Arts: A Beka
Mathematics: A Beka
Science: A Beka
Spanish, Music & PE: Independent
Curriculum
Elementary (K5-5th)
Bible: A Beka and Positive Action
for Christ
Health: A Beka
Language Arts: A Beka, Bob Jones
University
Mathematics: A Beka , Bob Jones
University
Science: Bob Jones University, A
Beka
History: A Beka
Spanish, Music & PE:
Independent Curriculum
Secondary (6th-12th)
Bible: Positive Action for Christ
English, Science, History, and
World Language: Bob Jones
University Press
Mathematics: Houghton Mifflin
Harcourt
Individual Study and Electives:
Accelerated Christian Education
(ACE), and many others
Advanced Online Electives:
Sevenstar Academy
PRESCHOOL: Through a warm, loving, and supportive environment, our preschool teachers interact with
children in a safe family atmosphere of caring discipline. Students are taught an academic based curriculum
that is designed to prepare them for our kindergarten program. The preschool academic and spiritual emphasis
includes daily Bible classes, language arts instruction using a phonics approach, numbers, handwriting, and
readiness skills. In order to qualify for our preschool program, a child must be the appropriate age by October
31st of that school year. K2 students must be two year olds in order to attend.
Preschool Core Subjects
Bible
Language Development
Numbers
Reading
Poetry
Phonics
Writing
Skills Development
Preschool Enrichment Subjects
Music
Arts
Crafts
Library
Spanish
Physical Education
Center Time – Intro to Computers, Manipulatives,
Creative Play, Story Time, Scissor Skills
ELEMENTARY: Our elementary school program, covering kindergarten through fifth grade, expands the
preschool academic vision. Elementary reinforces positive work habits while continuing to strengthen
cognitive abilities and critical thinking, a foundation proven to have a positive effect on our students’ test and
SAT scores.
Elementary Core Daily Subjects
Bible
Phonics
Language and language development
Science
Penmanship
Phonics
Mathematics
Spelling
Science
History
Reading
Creative Writing and Critical Thinking
Accelerated Reading Program
Elementary Enrichment Courses
Physical Education
Music
Spanish
Computer Technology Lab
Library
Art
Elementary students also participate in grade level drama productions and field trips
Additional fine arts for elementary school students include instruction in band, keyboard, piano, guitar, drums,
and violin. These classes are available for an additional fee.
AFTERSCHOOL CLUBS AND ACTIVITIES: Elementary students can join the Junior Mustangs
afterschool club. This program is offered to 1st-5th grade students and provides numerous fun and educational
opportunities such as cheerleading, soccer, flag football, chess, Destination Imagination, science, cake
decorating, etiquette and manners, dance troupe, and dealing with bullies.
MIDDLE SCHOOL: The SMCA Bible integrated middle school program gives students in grades six through
eight the opportunity to find their personal academic best. Middle school students build on the foundational
concepts learned in elementary, while gaining proficiency in the study skills that will make them successful in
high school. Seventh grade students take the TerraNova 3 standardized test.
Enrichment Courses –
Quarterly Rotation
Middle School Core Daily Subjects
6th grade
Bible
Reading
Language Arts
Science
History
Math Course 1 or
Honors Math Course 2
7th grade
Bible
English
Life Science
History
Math Course 2 or
Honors Pre-Algebra
Physical Education &
Health
8th grade
Bible
English
Earth Science
History
Pre-Algebra or
Honors Algebra I
Physical Education &
Health
Computer
Art
Spanish
Music
Additional fine arts for middle school students include instruction in band, keyboard, piano, guitar, drums, and
violin. These classes are available after school for an additional fee.
Middle School Interscholastic Competitions, Conferences & Honor Society
Qualifying middle school students have the opportunity to compete on the Spelling Bee team and the Math
Olympics team, and to attend the ACSI Middle School Leadership Conferences. National Junior Honor
Society for seventh and eighth students is by invitation, based on grades, community service, leadership and
character.
SPORTS: Our athletic program offers middle school students the chance to participate in a variety of
competitive interscholastic sports. SMCA’s student athletes and coaches work together to create a positive
environment designed to foster good sportsmanship and the development of Godly character.
In addition to serving our on-campus student body, our athletic department also ministers to the local home
school community by providing a limited number of openings on our sports teams for those students studying
at home.
Affiliations:
Metro Independent School Athletic League (MISAL) member
Maryland Public Secondary School Athletic Association (MPSSAA) non-member approved school
Teams compete in Soccer, Cross Country, Basketball, Cheerleading, Track & Field, and Baseball
AFTERSCHOOL CLUBS AND ACTIVITIES: Middle School students have an array of afterschool
activities to keep them busy after school. Each day, students can attend free Help Class sessions with their
teachers and also get involved in clubs such as: Chess, Art, Book, Robotics, Drama, and Bible Study.
SCHOOL SOCIAL EVENTS: Throughout the school year, students are invited to social mixer events just
for middle school. Such events include school dances, video game nights, Coffee House Night, bowling,
campfire cookouts and more!
HIGH SCHOOL: SMCA’s Bible-based high school curriculum equips students with the skills to be academically
competitive in college and to think critically in the 21st century workplace. Christian teachers guide students to find their
gifts that will lead them to the path God intends for them.
9th Grade
Core Daily Subjects
Bible
Algebra1 or Honors
Geometry
English or Honors English
Physical Science
World History
10th Grade
Core Daily Subjects
Bible
Geometry or Honors
Algebra 2
English or Honors English
Biology
US History
11th Grade
Core Daily Subjects
Bible
Algebra 2 or Honors
Advanced Algebra/
Trigonometry
English or Honors English
or AP English Literature
Chemistry
Government LSN
12th Grade
Core Daily Subjects
Bible
Advanced
Algebra/Trigonometry or
Calculus
English or Honors English
or AP English Literature
Physics
Life Skills
Resource Center:
Students may qualify to take classes in the Resource Center to enhance individual skills by studying a unique
curriculum at a slower pace, completing a course using the Accelerated Christian Education (ACE) program, or taking
an advanced online course.
Electives:
Spanish 1, Spanish 2, PE/Health, Advanced PE, Drama, Computer Applications, Yearbook, Teacher Aide, Office
Aide, Art, Calculus, AP Human Geography, Physics, or nearly 100 Online Classes, including AP and Dual Credit
College courses (College of Southern Maryland)
Standardized Testing:
Standardized Testing:
Standardized Testing:
Standardized Testing:
Terra Nova 3
PLAN (pre-ACT)
PSAT (pre-SAT)
Optional:
Optional:
Advanced Placement
Advanced Placement
*Seniors may be eligible for an internship or half-day college waiver, earning college credits through the Dual
Credit Program at the College of Southern Maryland for 50% cost on college tuition.
Additional fine arts for high school students include instruction in band, keyboard, piano, guitar, drums, and
violin. These classes are available after school for an additional fee.
LEADERSHIP OPPORTUNITIES:
Elected Student Government Association (SGA) officers help to organize special events, trips, chapels, and
retreats. Qualifying high school students are given the opportunity to attend the annual overnight ACSI
Leadership Conference. National Honor Society for high school students at SMCA is by invitation and is
based on grades, community service, leadership and character.
SPORTS: Our athletic program offers high school students the chance to participate in a variety of highly
competitive interscholastic sports. SMCA’s student athletes and coaches work together to create a positive
environment designed to foster good sportsmanship and the development of Godly character.
In addition to serving our on-campus student body, our athletic department also ministers to the local home
school community by providing a limited number of openings on our sports teams for those students studying
at home.
Affiliations:
Metro Independent School Athletic League (MISAL) member
Maryland Public Secondary School Athletic Association (MPSSAA) non-member approved school
Teams compete in Soccer, Cross Country, Basketball, Cheerleading, Track & Field, and Baseball
HIGH SCHOOL Cont.:
AFTERSCHOOL CLUBS AND ACTIVITIES: High School students have an array of afterschool activities
to keep them busy after school. Each day, students can attend free Help Class sessions with their teachers and
also get involved in clubs such as: Newspaper, Chess, Art, Book, Robotics, Drama, and Bible Study.
SCHOOL SOCIAL EVENTS: Throughout the school year, students are invited to social mixer events just
for high school. Such events include school dances (casual, semi-formal, formal), video game nights, Coffee
House Night, bowling, campfire cookouts and more!
GENERAL INFORMATION:
LEARNING MANAGEMENT AND NOTIFICATION SYSTEM: Parents are kept informed through
Renweb, a web-based school management system that includes parent emails, live progress reports, homework
assignments, behavior notes, lunch accounts, attendance, report cards, library accounts, school calendar, and
more! Important information and emergency information is distributed via Parent Alert cell phone texts,
voicemail, and emails.
DISCIPLINE: Our goal at SMCA is to develop intelligent Christian students who have a Christ-honoring
attitude in each area of their lives. As we all know, little would be accomplished academically and spiritually
to meet this goal without organized, disciplined, and quiet classrooms. Teachers are encouraged to work
toward this goal using a variety of positive reinforcement techniques throughout the year. A color-coded
behavior system for Elementary and a Demerit System for Middle School and High School are used. Both
systems are designed to not punish, but lead to correction.
The administration reserves the right to permanently expel a student if the above corrective measures have
failed and student misconduct persists.
LUNCH: Students may bring lunches or may purchase lunches offered from different restaurants daily.
SCHOOL HOURS: Secondary School starts at 7:55 a.m. and ends at 2:25 p.m.; Elementary School starts at
8:10 a.m. and ends at 2:40 p.m. Extended care is available before school (6:00 to 8:00 a.m.) and after school
(3:00 to 6:00 p.m.) for an additional cost.
UNIFORM DRESS CODE: Students at SMCA are required to wear uniforms. Our uniform supplier is
Lands’ End. To have as much uniformity as possible we require that you purchase all uniform items from
Lands’ End.
STATEMENT OF NON-DISCRIMINATION: The Southern Maryland Christian Academy admits students
of any race, color, national and ethnic origin to all the rights, privileges, programs and activities made available
to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in
administration of its educational policies, admission policies, athletics or other school-administered programs.
Why Christian Education?
By Maureen Gaines
Biblical Foundation
The Holy Scriptures are very clear that the responsibility of educating children rests solely with the child’s parents.
Deuteronomy 6:5-8 tells parents that they are to instruct their children in the things of the Lord and that they are to integrate
their instruction in all areas of their child’s life. As Christian educators we believe that Christian schools act “en loco
parentis” which is the Latin term which means “in the place of parents”. During the course of the average school day
Christian schools are integrating God’s truth into all areas of study the children are exposed to.
Public Schools as a “Non-Religious” Alternative?
It is a myth that public schools are non-religious institutions. Many a parent has bought the myth that public schools simply
exist as “educational institutions” and that they are neutral in all religious aspects. Wrong. There is absolutely no neutrality when it
comes to religious philosophy and public education. Humanism (the basic belief that man is his own source of truth) along with
many other ungodly philosophies flourish in the public school system. In fact, Humanism declared itself as a bonafide religion in the
1930’s. Humanistic philosophy is integrated into all aspects of public education. Children are robbed of the knowledge that Jesus
Christ embodies all truth and they are taught anti-Biblical thought.
Another good reason why public schools are not a good alternative for education is the impact that teachers have upon their
student’s lives. There are many, good, Christian teachers who devote their lives to ministering to children in the public sector. Praise
God for their diligence and missionary work. However, the majority of teachers who work in the public school system do not profess
to love God and the influence that they have upon their students is not scriptural. Jesus tells us in Luke 6:40, “A pupil is not above
his teacher; but everyone, after he has been fully trained, will be like his teacher”. Who do you want your children to be like? As
Christian educators we believe that students should be like Christian teachers who love God and know Jesus Christ as their personal
Savior. Christian teachers give their students advice from a biblical basis and refer students to God’s word for answers to life’s
questions.
The Issue of Sheltering Children
Some Christian parents have accused Christian schools of sheltering children from the “real world”. As Christian educators
we beg to differ and point out that the “real world” is where God is the focal point. The “real world” these parents are referring to is
absent and devoid of the full recognition of Jesus Christ as Lord and Savior. We also take point with the term “sheltering”. Since
when did the term “sheltering” take on a negative connotation? We would like to suggest the greenhouse as a good example of
biblical sheltering. The greenhouse exists to nurture plants that are unable to survive in the “harsh” environment of the real world.
Sheltering takes place by carefully attending to the precious plants until they are ready to function to their fullest ability in the “real
world”.
Final Conclusions
Christian schools exist to help parents train up their children in the things of the Lord. They also exist to guide children to
God’s truth as it exists in the academic realm. There is no such thing as the perfect Christian school for they are administered by
imperfect people who are sinful; however, we believe that they are a biblical alternative for parents who are seeking academic
excellence for their children’s education. Please make it a matter of prayer as you consider the grave responsibility you have to
educate your children.
Southern Maryland Christian Academy
Statement of Philosophy
“In whom (Christ) are hid all the treasures of wisdom and knowledge.” Colossians 2:3
“But to us there is but one God, the Father of whom are all things, and we in Him; and one Lord Jesus Christ,
by whom are all things, and we by Him.” I Corinthians 8:6
“For by Him were all things created, that are in heaven, and that are in earth, visible and invisible, whether they
be thrones, or dominions, or principalities, or powers: all things were created by Him, and for Him: and He is
before all things and by Him all things consist.” Colossians 1:16-17
The education process is dependent upon certain basic philosophies to provide the right viewpoint. These
basic truths are the principles for interpreting the facts encountered in life and the study of all subject matter.
We believe that the foundational concepts are:
1. God is the creator and sustainer of all things and the source of all truth.
2. God maintains control over His entire universe.
3. True meanings and values can be ascertained only in the light of His person, purpose and work.
4. Since all truth extends from God and the person of Jesus Christ, all truth must be obtained from a
Christ-centered position.
Southern Maryland Christian Academy, fully trusting the power of God, has set itself to the task of teaching
children a proper relationship with God. This teaching is concerned not only with the counselors of God
revealed in His word, but also in the counsels revealed in His World. We desire to teach that all truth is God’s
truth and Jesus Christ is central in all truth; again, not simply in Word, but in history, in geography, in music,
in the arts and in all disciplines of life.
Southern Maryland Christian Academy
Statement of Faith
WE BELIEVE:
That “All Scripture is given by inspiration of God, - by which we understand the whole book called THE BIBLE: that it is inerrant in
the original writing and that its teaching and authority are absolute, supreme and final; that the Holy Spirit guided the holy men of old
in all that they wrote.
The Godhead eternally exits in three persons—the Father, the Son and the Holy Spirit. These three are one God, having the same
nature, attributes and perfection.
In the Personality and Deity of the Lord Jesus Christ, begotten of the Holy Spirit, born of the Virgin Mary, truly God and truly man.
That man was created in the image of God, after His likeness, as stated in the word of God, but the whole human race fell in the fall
of the first Adam. Not only was his moral nature grievously injured by the fall but also he totally lost all spiritual life, becoming dead
in trespasses and sins, and subject to the power of the devil. “The carnal mind is enmity against God; for it is not subject to the law
of God, neither indeed can be. Therefore, he cannot enter the kingdom of God until he is born again by the Holy Spirit.
That Jesus Christ became the sinner’s substitute before God, and died as a propitiatory sacrifice for the sins of the whole world.
In the resurrection of the crucified body of Jesus Christ: that His body was raised from the dead according to the Scriptures, and that
He ascended into Heaven and sitteth on the right hand of God as the believer’s high priest and advocate.
That Christ in the fullness of the blessings He has secured by His death and resurrection is received by faith alone, and that the
moment we trust in Him as Saviour, we pass out of death into everlasting life. At the time of acceptance of Christ as Saviour, He
comes to dwell within the believer and to live out His life of holiness and power through Him.
That the Church is composed of all those who truly believe on the Lord Jesus Christ as Saviour. It is the body and bride of Christ.
Every believer, whether Jew or Gentile, is baptized into the body of Christ by the Holy Spirit, and having become members of one
another we are responsible to keep the unity of the Spirit in the bond peace, rising above all sectarian prejudices and denominational
bigotry and loving one another with a pure heart.
That all believers in our Lord Jesus Christ are called into a life of separation from worldly and sinful practices.
In the evangelization of the world, that the supreme mission of the people of God in this age is to preach the Gospel to every creature.
That special emphasis should be placed upon the evangelization of children.
In the personal return of our Lord and Saviour Jesus Christ, that the coming again of Jesus Christ is the “Blessed Hope” set before us,
for which we should be constantly looking. Our citizenship is in Heaven from whence we look for the Saviour.
That the souls of those who have trusted in the Lord Jesus for salvation do at death immediately pass into His presence, and there
remain in conscious bliss until the resurrection of the body at His coming, when soul and body shall be reunited with Him forever in
glory.
That the souls of the lost remain after death in misery until the final judgment of the great white throne. In the reality and personality
of Satan, “that old serpent, called the Devil, and Satan, which deceiveth the whole world.”
That marriage is God-ordained and the biblical institution of marriage is, as the Bible teaches, for one man to be married to one
woman. That God’s order for holy matrimony is between God, a man, and his wife; for the establishment of the individual family
unit in human society.
Southern Maryland Christian Academy
Application Procedures for New Students
An incomplete application will not be processed until all items are received.
1. Complete, sign and return the Application Forms in this packet. (3 pages)
2. Include a copy of:
• Transcript of grades from previous school (Grades 6-12)
• Most recent report card (Grades Kindergarten – 5th)
3. Include a copy of your child’s birth certificate.
4. Include a copy of your child’s (most current) immunization records.
5. Attach a letter of recommendation from a Pastor or role model, someone other
than parent.
6. Include a check, cash or money order for $30 made payable to SMCA. This
fee is not refundable. Applications will be processed in the order in which they
are received, only after all procedures have been followed and all paperwork
has been submitted.
7. Include a copy of a recent photograph (not returnable). This will be used for
identification & safety purposes.
8. Include any educational, psychological or other test results (i.e. IEP
evaluations) that may be pertinent.
Southern Maryland Christian Academy
9805 Faith Baptist Church Road
P.O. Box 1668, White Plains, Maryland 20695
301-870-2550
www.SouthernMarylandChristianAcademy.com
Application for Admission
For Office Use Only:
Date Received: _________
Date Accepted: _________
Date to Start: ___________
App Fee Paid: Check # ______ Cash ______
___BC ___ Transcripts ___ Photo
___Shot ___Report Card ___ Ltr of Rec
Please furnish all appropriate information. Please type or use black ink. One form per child.
STUDENT INFORMATION
Student’s Legal Name (Found on Birth Certificate): ______________________________________DOB*: ___________
Place of Birth: ____________________________ Grade Applying For: ____________ Date To Begin: ____________
Home Address: ______________________________________City: _________________State: _________Zip: ______
Home Phone: ________________________________ Neighborhood: ________________________________________
School/Daycare Last Attended: _______________________________________________________________________
Reason for Withdrawal: _____________________________________________________________________________
How did you become interested in SMCA? (circle) internet mailing newspaper
relative friend
other: ________
*Preschool and kindergarten children must be the appropriate age by October 31st of that school year
PARENT INFORMATION
Natural mother is: ( ) at child’s address; ( ) deceased; ( ) separated; ( ) divorced; ( ) single
Natural father is: ( ) at child’s address; ( ) deceased; ( ) separated; ( ) divorced; ( ) single
If divorced, who has legal custody for decision making? ( ) Joint ( ) Father ( ) Mother
Check all that apply:
(An official, complete copy of the most recent custodial court documentation is required for enrollment)
Father’s Name _______________________________________ Home Phone: _________________________________
Home Address: ____________________________________________________________________________________
Employer: ___________________________________Work Address: ________________________________________
Work Phone: __________________________________ Job Title: ___________________________________________
Email Address: ____________________________________________________________________________________
Cell Phone/Pager: ________________________________________________
Mother’s Name _________________________________________Home Phone: _______________________________
Home Address: ____________________________________________________________________________________
Employer: _____________________________________Work Address: ______________________________________
Work Phone: ___________________________________ Job Title: __________________________________________
Email Address: ____________________________________________________________________________________
Cell Phone/Pager: ________________________________________________
If there are other children in your family, please complete the following:
Name _______________________________________ Grade _________________ School _______________________
Name _______________________________________ Grade _________________ School _______________________
(1 of 3 pages)
Southern Maryland Christian Academy
9805 Faith Baptist Church Road
P.O. Box 1668, White Plains, Maryland 20695
301-870-2550
www.SouthernMarylandChristianAcademy.com
Application for Admission
SPIRITUAL BACKGROUND
Church attending: _____________________________________ Pastor’s Name: ________________________
What is the frequency of your family’s attendance: ( ) Weekly ( ) Frequently ( ) Infrequently
Please explain the involvement of your family in local church.
Please explain your reasons for choosing Christian education for your child.
Explain your reasons for choosing Southern Maryland Christian Academy as the education choice for your
student.
Are both parents in agreement on enrollment? If not, please explain.
Statement of Non-Discrimination
The Southern Maryland Christian Academy admits students of any race, color, national and ethnic origin to all
rights, privileges, programs and activities made available to students at the school. It does not discriminate on
the basis of race, color, national and ethnic origin in administration of its educational policies, admission
policies, athletics or other school-administered programs.
This information is true, correct, and complete to the best of my (our) knowledge.
Parent/Guardian Signature: ________________________________________ Date: _________________
Parent/Guardian Signature: ________________________________________ Date: _________________
(2 of 3 pages)
Application for Admission
MEDICAL AND EDUCATIONAL NEEDS
EDUCATIONAL NEEDS
Repeated a grade
Check one:
( ) No
( ) Yes
Has an IEP (Individualized Education
Plan), 504, ILP, or Service Plan
( ) No
( ) Yes
Diagnosed attention problems
Diagnosed learning disability
Received accommodations or
modification in the classroom
Received academic remediation or
tutorial assistance
Received speech therapy
Other
BEHAVIORAL NEEDS
Has been suspended from school
Has been expelled from school
Has been asked to withdraw from
school
Has a criminal or court record
Has been/is currently on probation
Other
MEDICAL/PHYSICAL NEEDS
Medical condition or specific health
need
Student will need to visit the school
health office for medicine/medical
procedure on regular basis
Medical condition that may be life
threatening
Psychological/Emotional need
Takes regular prescription
medication
Has allergies
Been pregnant, has/had a child, or
fathered/has a child
Other
( ) No
( ) No
( ) No
( ) Yes
( ) Yes
( ) Yes
( ) No
( ) Yes


( ) No
( ) Yes
( ) No
( ) Yes
Check one:
( ) No
( ) Yes
( ) No
( ) Yes
( ) No
( ) Yes
( ) No
( ) Yes
( ) No
( ) Yes
( ) No
( ) Yes
Check one:
( ) No
( ) Yes
( ) No
( ) Yes
( ) No
( ) Yes
( ) No
( ) No
( ) Yes
( ) Yes
( ) No
( ) No
( ) Yes
( ) Yes
( ) No
( ) Yes
If yes, explain:

Submit all IEP and official documents
regarding these
If yes, explain:
If yes, explain:
SMCA will not automatically deny a student based upon the information provided; however, providing
false information and/or omitting information may result in denial or expulsion.
The parent/guardian must present the most recent IEP, or other learning plans, for administrative
review prior to the parent/student interview. Use additional paper for detailed explanations.
To the best of my knowledge, the above information is accurate and true.
Signature of Legal Custodial Parent/Guardian: _________________________________ Date: __________
(3 of 3 pages)