EmailMe Form - Acadiana Christian Homeschool

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 every been tested or diagnosed with a reading or learning disability?

Yes

No

If yes, please explain.

Has the student ever been tested or is currently receiving speech, language, and/or occupational therapy?

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.

An application fee of $50.00 is required

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

HCA
218 Teljean Rd
Lafayette, LA 70503

Payment made be submitted via Venmo:

@ACHelementary

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

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