Application : Intermountain Adventist® Academy Grand Junction CO

Student Information

Student Name (First Middle Last)

Preferred Name

Grade Entering

Gender Male Female

Date of Birth

Age

Citizenship

Family Email

Home Address

Mailing Address (if different from home)

Denomination/Church

Family Information

Parent/Legal Guardian

Relationship to Student

Receive Grades Yes No

Custody Full Joint None

Email (if different from family email)

Address (if different from student)

Cell Phone

Work Phone

Occupation

Parent/Legal Guardian

Relationship to Student

Receive Grades Yes No

Custody Full Joint None

Email (if different from family email)

Address (if different from student address)

Cell Phone

Work Phone

Occupation

Are there any legal custody documents regarding student? Yes No

If yes, please upload a copy of any legal custody documents. (Or mail/bring to IAA office.)

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Personal Information

Has your student had his/her vision and hearing checked by a healthcare provider within the past year? Yes No

Are you aware of any medical concerns or issues that could affect your student’s school experience? Yes No

If yes, please explain.

Are you aware of any academic challenges or needs that could affect your student’s progress? Yes No

If yes, please explain.

Are you aware of any behavioral issues that could affect your student’s success in school? Yes No

If yes, please explain.

Has your child ever been suspended or asked to withdraw from school? Yes No

If yes, please explain.

Does your child currently have an Individualized Education Program (IEP/ISP)? If yes, full acceptance is conditional upon review of plan. NEW students must provide a copy of plan. Yes No

If yes, please upload a copy of your child's IEP paperwork. Please include the most recent evaluation as well.

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Each student must have a copy of his/her birth certificate on file in the office. Please upload here or submit a copy to the office. Returning students may already have the certificate on file. The application will not be considered complete until the birth certificate is on file in the office.

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Student Pledge

As a student of Intermountain Adventist Academy, I will: - Show respect to all. - Demonstrate a positive and caring attitude. - Do my best in school. - Use my strengths and abilities to serve others. - Take responsibility for my actions. - Care for school property. - Complete my work and prepare for tests. - Seek help when I encounter problems. - Uphold the Christian principles and guidelines as presented in the school handbook of Intermountain Adventist School. I have read this pledge and have shared it with my child. Yes

Parent Pledge

Understanding that the school has created a community to help students excel spiritually, academically, physically and emotionally, I agree to be a partner with the school by: - Providing adequate sleep and nutrition for my child and making time as needed at home to help my child succeed. - Volunteering 40 hours per school year. - Communicating questions or concerns directly to the teacher. - Supporting the school’s vision. - Accepting financial responsibility. I have read the parent agreement. Yes

State law requires that all children in public and private schools, preschools, Head Start and certified child care facilities have up-to-date immunizations, or have a religious or medical exemption. Please attach a copy of your child's CURRENT immunization record or exemption paperwork or submit a copy to the office. Your application is not complete until we have immunization record on file.

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Internet Agreement

- I understand that the internet can connect me to much useful information. - I will only use if for educational purposes - I will not look at or participate in anything that is illegal, dangerous, offensive or opposed to the Christian values of IAA. - I will not reveal home addresses or phone numbers (mine or anyone else’s) - I will not use the internet to annoy or offend anyone else. - I understand that if the school decides I have broken these rules, appropriate action will be taken. Any activity not in compliance with these rules may result in a loss of access as well as other disciplinary or legal action. - I understand that the internet usage is a privilege. If my grades drop below a C, I understand I may lose internet privileges until the next weekly grade sheet shows my grades have risen to C or above. I have read this agreement and have shared this information with my child. Yes

School Promotion

I recognize that school activities are often photographed and/or videotaped. These photos and videos may be used or shown on social media, the school website, a school yearbook, and other advertisements/promotional materials for Intermountain Adventist Academy. I understand that I must give written notice to IAA if I refuse to give consent for the use of any photographs or videos of my child in any school publication or for promotional activities. I have read the above statement regarding student promotional materials. Yes

Directions regarding photos/videos:

Acknowledgment of Handbook

I have received the current Intermountain Adventist Academy Handbook. (The handbook is available to download from the IAA website.) Yes

I understand that I have read or will read the entire handbook and follow all the policies and procedures written in the handbook. Yes

Music Acknowledgment & Agreement

I/We, the parent(s)/guardian(s) of an IAA student, support the music program and agree to have my child(ren) at any school sponsored program where their attendance is required. Should my child be sick for any performance date, I will contact the music teacher and/or homeroom teacher immediately. Yes

Previous School

Address

Phone

Fax

Parent / Guardian Signature

I certify that, to the best of my belief, the information I have provided is complete and true. I agree to the policies as outlined in this application and in the school handbook. By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received and with instructions to submit your $150 deposit fee to complete the application.

Signature

Date

Intermountain Adventist^® Academy

Where Character and Intellect Meet

Application

Student Information

Family Information

Personal Information

Student Pledge

Parent Pledge

Internet Agreement

School Promotion

Acknowledgment of Handbook

Music Acknowledgment & Agreement

Related Information