Diploma Program Application
$5 Application Fee
Please completely fill out the following:
Tell us about your family
Father’s full name: __________________________________________Relationship to student: _____________________
Mother’s full name: _________________________________________Relationship to student: _____________________
Student’s full name: ________________________________________ Student’s birth date: _______________________
Mailing address: ____________________________________________________________________________________
City, State, Zip code: ________________________________________________________________________________
Home phone: _____________________________________ Cell phone: _______________________________________
Work phone: ________________________________ Parent Email: ___________________________________________
Student’s email: __________________________________ (will only be used to notify of upcoming events and deadlines)
☐ I am a new member of CHESS
☐ I have been enrolled in CHESS for two or more years
Tell us about your student
Student is entering as: ☐ Freshman
☐ Sophomore
☐ Junior
(If you are a senior, please contact the CHESS office)
What is the highest level of education your student expects to complete?
☐ High School ☐ Vocational/technical program ☐ 2 year college degree ☐ Bachelor’s degree ☐ Graduate school
What colleges are you hoping your student will be applying to? ______________________________________________
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Is your student planning on/interested in participating in NCAA sports or a military academy?
How many hours per week does your student spend on:
☐ Television ________
☐ Video games _________
☐ YES
☐ NO
☐ Internet _________
What are your academic goals for your student? ___________________________________________________________
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What are your spiritual goals for your student? ___________________________________________________________
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On a scale of 1-10 (10 being the highest) please rate your student’s academic work ethic. __________
On a scale of 1-10 (10 being the highest) please rate your student’s spiritual strength. ___________
Please list 2-5 things you think are your student’s greatest strengths. ___________________________________________
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Please list 2-5 things you think are your student’s greatest weaknesses. _________________________________________
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How high of a priority is Biblical character training or Christian Worldview training in your high school education?
☐ 5 (very important)
☐ 4
☐ 3
☐ 2
☐ 1 (not important at all)
What are the main reasons you would like to use the CHESS Diploma Program? _________________________________
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If transferring from a public or private school, please answer the following questions.
What is your primary reason for withdrawing?_____________________________________________________________
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Is the student involved in any court cases or social service proceedings? ☐ No ☐ Yes (please explain situation, court
orders, and/or charges) _______________________________________________________________________________
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Has the student been suspended or expelled?
☐ No ☐ Yes (please explain)
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What is your primary reason for choosing home schooling as your new form of education?_________________________
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Please mail this form along with the student portion and the $5 application fee to (Incomplete applications cannot be
processed.): Colorado Heritage 2032 35th Avenue, Suite A #504, Greeley, CO 80634
Enrollment in the Colorado Heritage Diploma Program is on a year-by-year basis. To qualify for acceptance each
year the student must have completed all work he/she has agreed to do and be current with their tuition payments.
The Colorado Heritage Diploma Program is Judeo-Christian in approach and philosophy.
Signatures of both parents (or the legal guardians) and the student, are required.
Father’s signature
Mother’s signature
Student’s signature
Date
Office Use Only
Date Reviewed: ____/_____/_____
☐ CD & handbook sent ☐ Entered in DB Date:____/_____/____ ☐ Approved ☐ Not Approved Program: _____________________
☐ Accept letter sent
☐ Credits Transferred
☐ Invoice sent
☐ 4 Year planning meeting set up
Student Section
(To be completed by the student)
It is our desire to provide the best possible help for you as you go through high school and prepare for your
future. To help us help you, please answer the following thoroughly.
Do you want to pursue your high school education at home? ☐ Yes
☐ No Explain why or why not. ____________
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What are the main reasons you would like to use the Colorado Heritage Diploma Program? ________________________
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What is the highest level of education you expect to complete?
☐ High School ☐ Vocational/technical program ☐ 2 year college degree ☐ Bachelor’s degree ☐ Graduate school
Are you planning on/interested in participating in NCAA sports or a military academy? ☐ YES
☐ NO
What are your academic goals? ________________________________________________________________________
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What are your spiritual goals? _________________________________________________________________________
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Please list 2-5 things you think are your greatest strengths. __________________________________________________
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Please list 2-5 things you think are your greatest weaknesses. ________________________________________________
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Do you consider yourself a leader? ☐ Yes
Are you a Christian? ☐ Yes
☐ No
☐ No
How high of a priority is Biblical character training or Christian Worldview training in your high school education?
☐ 5 (very important)
☐ 4
☐ 3
☐ 2
☐ 1 (not important at all)
Which of the following do you participate in on a regular basis?
☐ Church
☐ Youth Group
☐ Sunday School
☐ Bible Study
☐ Personal Devotions
☐ Other:____________________
What is your life goal? _______________________________________________________________________________
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Please write out your salvation testimony on the back of this page.
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