GOODPASTURE CHRISTIAN SCHOOL
619 Due West Avenue
Madison, TN 37115
ADMISSION APPLICATION
The purpose of Goodpasture Christian School is to train young people to lead fully developed Christian
lives. Goodpasture Christian School admits students of any race, color, and national or ethnic origin.
This admission application cannot be finally approved until all recommendations have been checked.
STUDENT INFORMATION (Please Print)
Name_____________________________________________________________________________ M___F___ Phone_________________
Last name
First Name
Middle Name
Address___________________________________________________________________________________________________________
Street Address
Apartment No.
Email Address
__________________________________________________________________________________________________________
City
State
Zip Code
County
Name student is called ____________________________ Social Security No. _______________________ Date of Birth _______________
Place of Birth City/State _____________________________________________________________________________________________
Applying for (circle grade): PK3 PK4 K P1 1 2 3 4 5 6 7 8 9 10 11 12 Beginning in the Fall of 20________ or _________________
List any extracurricular interest. _______________________________________________________________________________________
FAMILY INFORMATION
Father’s name__________________________________________________________ Cell No.________________________________________________
Place of employment_______________________________________ Position ___________________________ Bus. No. ___________________________
Mother’s name_________________________________________________________ Cell No.________________________________________________
Place of employment_______________________________________ Position ___________________________ Bus. No.____________________________
Maternal grandparents____________________________________________________________________________________________________________
Name(s)
Address
Phone
Paternal grandparents_____________________________________________________________________________________________________________
Name(s)
Address
Phone
Are natural parents living together?_________ If not, who has legal custody of this student?____________________________________________________
With whom does student live?__________________________________ Church Affiliation of Family___________________________________________
Brothers/sisters currently enrolled in Goodpasture______________________________________________________________________________________
Relatives currently/previously enrolled in Goodpasture__________________________________________________________________________________
Alumnus: Father year graduated ______________ Mother year graduated _________________ Grandparents year graduated _______________________
EDUCATIONAL BACKGROUND
Last school attended______________________________________________ Grade _________ Phone _(_____)_______________________
_________________________________________________________________________________________________________________
Address
City
State
Zip
Has applicant ever been suspended, dismissed or asked to withdraw from any educational institution? Yes _____ No _____
If yes please state circumstances involved? ______________________________________________________________________________
Has applicant been in a resource or tutorial Program? Yes _____ No _____
Does applicant have any physical or emotional condition for which regular medication is taken? Yes _____ No _____ If yes describe.______
_________________________________________________________________________________________________________________
Does the applicant have a learning difference? Yes _____ No _____
Has the applicant ever been recommended for testing? Yes _____ No _____
If possible please provide a picture of the student(s).
In case of emergency, person to be notified if parent cannot be reached.
Name ___________________________________ Relationship to applicant ________________ Phone Number ______________________
Applicant’s doctor_____________________________________ Address/Phone ________________________________________________
List any physical or chronic illnesses and any medications required. ___________________________________________________________
_________________________________________________________________________________________________________________
The student and parent(s) agree to abide by all regulations of Goodpasture Christian School if student is accepted for admission.
An application fee of $100.00 must accompany each application, along with a copy of the latest report card (grades 1-12) and
a copy of the most recent achievement test scores (grades 3-12).
Applications filed without the application fee will not be processed.
Signed ________________________________________________________________
Date __________________________________________________________________
FOR SCHOOL USE ONLY
FEE PAID ______________ CHECK NO. ______________ DATE _______________ NAME_______________________________
Interview Date _________________
Results _______________________________________________________________________
Screening/Test Scores __________________________________________________________ Grades Requested _________________
Principal’s Comments __________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Letter of Acceptance _______________________ Letter of Denial _____________________ Waiting List _____________________
Principal Approval ___________________________ Admissions Approval ___________________________ Date ______________