EmailMe Form - Heritage School of Texas Application for Admission

Applying to Grade: *

Current Grade: *

Candidate Information:

Candidates's First Name: *

Candidate's Preferred Name:

Candidate's Middle Name:

Candidate's Last Name: *

Gender: *

Male

Female

Date of Application:

MM / DD / YYYY

Home Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone: *

### - ### - ####

Mother's Cell:

### - ### - ####

Father's Cell:

### - ### - ####

Date of Birth: *

MM / DD / YYYY

Place of Birth:

Age in Years:

Ethnicity (optional):

Father's Information:

Father's Name:

First Last

Father's Preferred Name:

Father's Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Business Name:

Occupation/Position:

Business Phone:

### - ### - ####

Father's Email:

College(s) Attended:

Mother's Information:

Mother's Name:

First Last

Mother's Preferred Name:

Is Mother's Address same as Father's?:

Yes

No

Mother's Address (if different):

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Business Name:

Occupation/Position:

Business Phone:

### - ### - ####

Mother's Email:

College(s) Attended:

Family Information:

Please List Names of Other Children in Family:

Other Child Name 1:

Other Child Age 1:

Other Child School 1:

Other Child Name 2:

Other Child Age 2:

Other Child School 2:

Other Child Name 3:

Other Child Age 3:

Other Child School 3:

Other Child Name 4:

Other Child Age 4:

Other Child School 4:

Check if Appropriate:

Candidate Lives With:

If parents are separated or divorced, send admission correspondence to:

Father

Mother

If parents are separated or divorced, who has legal custody?

Stepmother's Name (if applicable):

First Last

Stepfather's Name (if applicable):

First Last

Father's Church Affiliation:

Mother's Church Affiliation:

Candidates's Church Affiliation:

List any Heritage families whom you know (if applicable):

How did you become interested in Heritage?

School Information

Current School Name:

Current School:

Independent

Public

Current School Address:

Street Address City State / Province / Region Postal / Zip Code Country / Region

Current Principal/Head of School: *

First Last

Current School Main Phone: *

### - ### - ####

Principal/Head of School Email *

Current Teacher: *

First Last

Teacher Phone Number:

### - ### - #### Ext. ###

Teacher Email *

List other schools attended by the candidate, grades, and addresses:

Has student previously applied for admission to Heritage?

No

Yes - Year(s):

Has student ever skipped a grade?

No

Yes - What Grade?:

Has student ever repeated a grade?

No

Yes - What Grade?:

Has student been given diagnostic testing?

No

Yes*

*If yes, please describe briefly and attach a copy of report:

Has the candidate ever received tutoring outside of the classroom? If so, please indicate the grade(s), subject(s), and circumstances:

Does your son/daughter have any record of school disciplinary problems?

No

Yes*

Has your son/daughter ever been dismissed or suspended from any school?

No

Yes*

*If yes, briefly describe the nature of the situation:

Additional Information

Comment on your son's/daughter's greatest strengths and abilities:

Are there any special circumstances of which the School needs to be aware to better evaluate your child?

What are your son's/daughter's special interests and extracurricular activities?

Please provide us with your parental perspective on your child’s emotional, spiritual, and physical development. We appreciate your effort in helping us to know your son or daughter better.

Describe the ways in which you integrate your faith into your family’s life:

After becoming acquainted with Heritage’s Mission & Vision Statement and Doctrinal Statement, describe your expectations of the School and how you see your family as part of Heritage.

Describe how discipline is handled in your home:

Required files to upload:

Candidate Birth Certificate: *

(.pdf, .jpg, .gif, .png, .tif, .doc, .docx, .hec)

Photo of Family:

(.pdf, .jpg, .gif, .png, .tif, .doc, .docx, .hec)

Current Immunization Record: *

(.pdf, .jpg, .gif, .png, .tif, .doc, .docx)

Transcript (classes 2 through 5): *

(.pdf, .jpg, .gif, .png, .tif, .doc, .docx)

Teacher Evaluation / Diagnostic Testing Reports (if applicable): *

(.pdf, .jpg, .gif, .png, .tif, .doc, .docx)

$150 Application Fee (non-refundable):

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Name on Card

First Last

Billing Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Credit Card Type:

Credit Card *

Contact Phone: *

### - ### - ####

Email Address (for receipt): *

I authorize Heritage School of Texas to charge a non-refundable application fee amount of $150.00 to my card as listed above:

Yes

No

Signature: *

By entering your name and initials, you electronically authorize as specified in the above document.

Initials: *

By entering your name and initials, you electronically authorize as specified in the above document.

Signature *

Clear