EmailMe Form - ACH Middle and High School

Student's Name *

First Last

Grade Entering Fall 2024 *

Date of Birth *

MM / DD / YYYY

Gender *

Male

Female

Address *

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

Parent / Guardian 1

Name

First Last

Relationship

Phone

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

Email

Parent / Guardian 2

Name

First Last

Relationship

Phone

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

Email

Current school and reason for leaving

Has your child has ever been retained ?

Yes

No

If yes, please explain.

Has the student ever been tested or diagnosed with a reading or learning disability?

Yes

No

If yes, please explain.

Does the student have an IEP or receive 504 services?

Yes

No

If yes, please explain.

Does the student have any special medical conditions?

Yes

No

If yes, please explain.

How did you hear about Acadiana Christian Homeschool?

Attach additional Word, Powerpoint, PDF or text document if necessary.

I understand that this application is for admission only for the term indicated. I agree that I am bound by the ACH’s regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports.

I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or will result in denial of admission and invalidation of credits earned.

If admitted, I agree to abide by the policies, rules and regulations of ACH. Should any information change prior to my entry into ACH, I will notify the Office of Admissions.

I understand that the application fee I submit with this application is a non-refundable fee.

By typing your name you agree to the terms of this application *

An application fee of $50.00 is required

Payment can be made via check mailed to or dropped off at:

CT SERVICES
218 Teljean Rd
Lafayette, LA 70503

The application will not be processed until payment has been made.

If paying by Credit Card enter details below.

Name

First Last

Credit Card Zip Code

Price

$ Dollars . Cents