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Child's Name

First

Middle

Last

Preferred name *

Is the applying student a Christian? *

My child is applying for *

When would you like your child to begin? *

Fall 2025

Fall 2026

Fall 2027

I'm not sure yet.

My child is a *

new ACA student.

former student.

What semester and year did you last attend ACA? *

Why do you wish to return? *

My child is a *

US citizen

non-US citizen

Country of citizenship *

Physical address *

Physical address

City

State/Province

Zip/Postal

Physical address *

Physical address

City

State/Province

Zip/Postal

Country

My mailing address is different than my physical address.

Yes

Mailing Address

City

State/Province

Zip/Postal

Mailing Address

City

State/Province

Zip/Postal

Country

Date of birth *

mm/dd/yyyy

Birth place *

City, State

Sex *

Male

Female

Ethnicity *

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Multi-racial

Native Hawaian or Other Pacific Islander

White

Last school attended *

Last school's city and state *

Grade student was in as of February 1st *

What school is your child assigned to by the Ohio Department of Education? *

Has the student every been put on probation, expelled, dismissed, suspended, or refused admission to another school? *

yes

no

If yes, please explain. *

Has the student ever had disciplinary difficulty at school? *

yes

no

If yes, please explain. *

Does the student have a juvenile or arrest record? *

yes

no

If yes, please explain. *

Has the student ever failed an academic subject in school? *

yes

no

If yes, please explain. *

Academic level of student's previous work *

excellent

good

average

poor

Student's physician *

Physician's phone number *

The Ohio Department of Education requires that all students' immunization records and a copy of birth certificate be on file at the beginning of the school year. If they are not on file after 15 days from the start of school, the student will NOT be permitted to remain at school. This is strictly enforced.

Is your child taking a medication that needs to be administered during the school day? Please follow this link and fill out the form to bring to your interview at the school.

Health Conditions

What type of allergies?

What type of cancer?

What type of heart disease?

Injuries and Illnesses

Please list any severe injuries or illnesses including the age of the child at time of injury or illness and if they were hospitalized.

Additional health comments

Do you have other comments or concerns about the child's health, development, behavior, family, or home life that you would like the school to be notified about?

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Student Info

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