This student application form is for current CHA families who wish apply for enrollment in Kindergarten through Grade 12 for a sibling of their current student(s). For your application to be considered complete, our Admissions office must also receive the following for this applicant:

A non-refundable application fee of $130 per student
Copies of the last three years of report cards
Standardized test scores
Diagnostic test or formal evaluation results (if applicable).
Original birth certificate
Pastor Reference Form (needed only if your family has changed churches since your previous application)
Middle and Upper School students only:
- Student Response Form (available from the Admissions office)
- Parent/Student Expectation Form (available from the Admissions office)

F-1 Visa Students: Application fee is $300. Application by parent and guardian is needed along with personal interview of guardian and student. English writing sample by student is also required. All admission steps must be complete and student must be accepted before school can issue an F-1 Visa.

"*" indicates required fields

HOUSEHOLD INFORMATION

Consent*

In submitting this application, I/we understand and am/are in full agreement with the Statement of Faith and Philosophy of Education of Christian Heritage Academy, and will fully cooperate in having my/our child educated in accordance with this Christian perspective.

Please indicate that you agree to the statement above by checking the box at left and entering your name below. as the person completing this form

Person Completing this Form*

First Middle Last

Household Last Name*

Please enter the one last name that your family is referred to in our records.

STUDENT APPLICANT INFORMATION

Applying Student Name*

Please enter the first, middle, and last name of the child for which you are applying.

First Middle Last

Preferred First Name*

Is there a (nickname) that your child generally goes by with family and friends? If so, please enter it here (if not, please enter NA):

Gender*

Male

Female

Date of Birth*

Month

Day

Year

Siblings*

Please click the plus sign at right to add another sibling.

Name

Age

Entering Grade

Current School

Applying to CHA? (yes or no)

Please select desired enrollment date*

August of the coming school year

January of the current school year

For Kindergarten Applicants Only. (Please disregard if student is entering Grades 1-12.)*

Please select desired program option. PLEASE NOTE: To enter Kindergarten, child must be 5-years-old by Sept. 1.

Kindergarten Full Day - 8:15 AM-3:15 PM (M-Th), 9:00 AM-3:15 PM (F)

Kindergarten Combo (MWF Full Day plus T/Th Mornings) - 8:15 AM-3:15 PM (M/W), 9:00 AM-3:15 PM (F); 8:30-11:30 AM (T/Th)

Kindergarten Mornings - 8:15 AM-11:30 (M-Th), 9:00-11:30 (F)

PARENT/GUARDIAN INFORMATION

FATHER or MALE GUARDIAN

Father or Male Guardian Name

Prefix First Middle Last

Father/Male Guardian Address

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

Father's/Male Guardian's Phone

Father/Male Guardian's Email

Marital Status

Married

Separated

Divorced

Single

Relationship to Applying Child

Father

Male Guardian

Uncle

Grandfather

Does Applicant live with you?

Yes

Do you have custody?

Yes

What church do you attend?

Please include campus and/or location.

PARENT/GUARDIAN INFORMATION

MOTHER or FEMALE GUARDIAN

Mother or Female Guardian

Prefix First Middle Last

Mother/Female Guardian Address

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

Mother's/Female Guardian's Phone

Mother's/Female Guardian's Email

Marital Status

Married

Separated

Divorced

Single

Relationship to Applying Child

Mother

Female Guardian

Aunt

Grandmother

Does Applicant live with Mother/Female Guardian?

Yes

Does Mother/Female Guardian have custody?

Yes

What church does Mother/Female Guardian attend?

Please include campus and/or location.

SCHOOL HISTORY

Please list the schools that your child has attended.*

To add more siblings, click the plus sign on the right.

Name of School

Address

Grades Attended

Reason for Leaving

Has your child ever repeated a grade?*

Yes

If yes, please enter grade repeated.

Has your child ever been enrolled in a gifted or accelerated program?*

Yes

If yes, in what enrichment activities have they participated?

LEARNING & SOCIAL INFORMATION

Child's Academic Strengths*

Please describe:

What expectations do you have of the education that your child will be receiving at Christian Heritage Academy?

Does your child have difficulty with any of the following. Please check any and all options that apply.*

Behavior

Attention

Work Habits

Oral Expression

Written Expression

Socialization

Other

None observed

If yes, please explain:

Has your child been professionally evaluated for any of the following? Please check any and all options that apply.*

Speech and language development

Hearing or vision problems

ADD/ADHD

IEP/504

Other

N/A

If any of the above evaluations have been done, please attach all full, related diagnostic reports. Also, please add any additional information in this regard that we should know.

Does your child have any allergies or other health concerns that we should be aware of?*

SUBMIT APPLICATION FORM

You have reached the end of the Sibling Preschool Application Form. Please check to ensure that all required entries have been made.

After selecting the "Submit" button below, please scroll down to find your Confirmation message to appear on this page.

NON-DISCRIMINATION STATEMENT: Christian Heritage Academy admits students of any race, color, sex, and national or ethnic origin, to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, sex, or national or ethnic origin, in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs. Christian Heritage Academy does reserve the right to select students on the basis of academic performance, religious commitment, philosophical compatibility, and willingness to cooperate with the Christian Heritage Academy administration and abide by its policies. Excerpted from the Constitution of the Association of Christian Heritage Academy, adopted 1984.

Phone

This field is for validation purposes and should be left unchanged.

Christian Heritage Academy

315 Waukegan Road

Northfield, IL 60093

847 446-5252 | (fax) 847 446-5267

Facilities | Employment | Contact