2019-2020 International Student Application

This application form is for new international students applying for admission into Berean Academy. A $50 application fee is required, which covers application processing, domestic transcript analysis, and new student testing.

Date of Application *

Month Day Year Date Picker Icon

School Year *

Child's Name *

First Name Middle Name Last Name

Child's Birth Date *

Month Day Year

Child's Gender *

Male Female

Country of Birth *

Country of Citizenship *

Grade Applying for *

Requested Start Date (Semester & Year) *

Does the student plan to graduate from Berean Academy? *

Yes No Unsure

Expected Completion Date (Semester & Year) *

Visa Type *

F-1 J-1

Attendance Type *

Initial Attendance at a U.S. School Change of Status

Parent/Guardian Information

Guardian 1's Name *

First Name Last Name

Foreign Address 1

Foreign Address 2

Foreign City

Foreign Province/Territory

Foreign Postal Code

Foreign Country

Do you have hosting/housing arrangements in the U.S.?

Yes No

U.S. Address (if applicable)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Name of International Guardian

First Name Last Name

International Guardian's Employer

International Guardian's Occupation

What is the relationship of the international guardian to the student?

International Guardian's Phone Number

International Guardian's E-mail

Name of U.S. Guardian (if applicable)

First Name Last Name

U.S. Guardian's Employer (if applicable)

U.S. Guardian's Occupation (if applicable)

U.S. Guardian's Address (if applicable)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What is the relationship of the U.S. guardian to the student?

U.S. Guardian's Phone Number

Area Code Phone Number

U.S. Guardian's E-mail

Student's Background Information

Church Membership? *

Yes No

Name of Church

Please list each school the student has attended starting with the most recent. *

Has the child ever been asked to repeat a grade? *

Yes No

If yes, which grade(s)?

Has the child ever been suspended or asked not to return to a school? *

Yes No

If yes, please write an explanation.

State any chronic health, emotional, or physical problem(s) the child has.

Does the child have any learning diffiiculties? *

Yes No

Does the student require modifications to meet academic requirements? *

Yes No

If you answered "yes" to either of the previous two questions, please explain.

Is the student proficient in English? *

Yes No

Note: Berean Academy does not have an English as a Second Language program. All instruction will be in English.

Reference

Please name a reference (non family member) for the child who can provide information relevant to his or her character.

Name of Reference

First Name Last Name

Reference's Phone Number

Area Code Phone Number

Reference's Relationship to the Child

Writing Sample

The international student is to submit a writing sample along with this application. The composition is to address two topics:

The applicant is to explain his/her purpose and goals concerning studying in the U.S.
The applicant is to explain or describe his/her spiritual beliefs.

Upload the writing sample here. *

In making this application, I understand that

Since the fees do not cover the actual cost of educating my child, we recognize that our participation is needed in prayer, service, and gifts in order to properly share in his/her training.
The school reserves the right to dismiss any student who does not respect its standard or cooperates in the educational process.
After acceptance, a place will be held for my child when te enrollment form and teh non-refundable registration fee have been submitted to the school by the date indicated on the acceptance letter.
It is hereby understood that the guardians will pay tuition for the amount stated by the school office. No refunds will be made for fees. Children transferring to another program and having attended one day or more of any month will owe the full month's tuition.

Statement of Cooperation

I pledge loyalty to the aims of the school and will bring any and all questions and criticisms directly to the administration so that they may be properly considered by those in authority.
We will read the Statement of Faith and the Philosophy of Education and are willing to have our child trained in accordance with them.
We will read the Student Handbook and will cooperate fully in seeing that the rules and regulations laid down there are met.
I give Berean Academy permission for my child to take part in all school activities, including sports and school-sponsored trips away from the school premises.
The teacher and administration are hereby given full discretion in the discipline of our child. This would include the issuing of suspensions and expulsion from the school program.
I agree to hold the school and its agents harmless for any liability to my child or any guardian or parent thereof because of any claims on behalf of my child against the school or any agent thereof because of any injury or alleged injury to my child. Should legal action, for any reason, be taken against Berean Academy or any employee or agent thereof, on my child’s behalf and the school or its agent not be found at fault, I agree to pay any attorney fees, damages or other costs that Berean Academy or its agent should incur to defend itself against such action, and would immediately withdraw my child from school as soon as such action had begun.
This statement of cooperation will be in effect for as long as my children attend Berean Academy or Preschool.
The school reserves the right to dismiss any student who does not cooperate with the educational process. If a student is dismissed for any reason, the tuition will be prorated on a monthly basis for that period of time that the child is in school.

Notice of Non-Discrimination

Berean Academy admits all qualified applicants regardless of race, gender, color, or national and ethnic origin.

Confirmation/Submission

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature of Person Completing the Application: Use your mouse to sign. *

FEE

Registration Fee $ 50.00

2019-2020 International Student Application

International Student Application for Admission