UBIC Academy Student Enrollment Pack
This form must be completed before acceptance at UBIC Academy
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Student Name: (First, Middle, & Last) *
Address: (Include City, State, & Zip) *
Telephone Number *
Student Date of Birth *
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Last School Attended *
Parent Email Address *
Student Grade Level Upon Enrollment *
Guardian's Name: (Include all legal guardians first & last name) *
Guardian Employment: (Include all legal guardian's places of employment & their work phone number)
Emergency Contact Numbers  *

Children in the home of school age, not applying: (Include their age & the reason they are not applying)

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Does your family attend church? (If YES, answer the next question)
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What church does your family attend?

Has the applicant ever made a profession of faith in Christ? 

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Has your student ever been expelled, dismissed, suspended, or refused admission to another school? (If YES, answer the next question)

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Reason for previous expulsion, dismissal, suspension, or refused admission to another school.

Has your student ever had disciplinary difficulty at school? (If YES, answer the next question)

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What disciplinary difficulties has your student had at their previous school?

Please indicate academic level of student's previous work:

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Required

How did you hear about this school?

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Required
I have read and agree to UBIC Academy's Honor Code (Find UBIC Academy's Honor Code at ubicacademy.com/enrollment-pack) *
I authorize UBIC Academy to request records from applicants previous school *
I have read and understand UBIC Academy's Pick-up & Drop-Off Form (Find UBIC Academy's Pick-up & Drop-Off Form at ubicacademy.com/enrollment-pack)
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Names of people permitted to pick up my child from school: (Include their first and last name and telephone number) *

“I have read the Student Handbook and agree and understand the terms stated on this Application and agree thereto.” 

“I understand the school reserves the right to dismiss any student who fails to comply with the established regulations and discipline or whose financial obligation remains unpaid. 

“I appreciate the school's standards and do not tolerate profanity, obscenity in word or action, dishonor to God and the Word of God, or disrespect to the school's personnel. 

“I agree to uphold and support the high academic standard of the school by providing a place at home for my student to study and giving my student encouragement in the completion of any homework or assignments. 

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Name of person filling out this form. (Include first & last name) *
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