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119B N. Klevin
Anchorage, AK 99508
 
907-272-3617
truevineministries
@gci.net
 
TVCS Student Application

  STUDENT INFORMATION

                                      Term   Date

Last Name  First Name   Middle 

Address   City   State ZIP 

Telephone# 

Age Sex  Birth Date  Birthplace

School Last Attended
Address
Last Grade Completed


             Family Information

Father's Name
      Employment   Position
      Business Phone  Cell# Email

Mother's Name
      Employment   Position
      Business Phone   Cell#   Email

Emergency telephone number, other than those already listed:
Marital Status: Married Divorced  Widow  Separated

Children in family of school age if not applying:
          Name  Age

Reason they are not applying:


            RELIGIOUS INFORMATION

Church Attending   Pastor  Phone
Father: Christian? Yes  No  Mother: Christian? Yes  No
Has applicant ever made a profession of faith in Christ? Yes  No

           MEDICAL INFORMATION

Family Physician   Phone#
Does student have any physical defects or allergies? Yes  No
          If yes, please explain:
Has student received immunizations: Diphtheria   Smallpox   Polio

           SCHOLASTIC INFORMATION

Has student ever been expelled, dismissed, suspended, or refused admission to another school? Yes No
          If yes, please explain:
Has student ever had disciplinary difficulty at school? Yes No
          If yes, please explain:
Does student have a juvenile or arrest record? Yes No
          If yes, please explain:
Has student ever used tobacco or nonprescription drugs of any kind? Yes No
          If yes, please explain:
Please indicate academic level of student's previous work: Excellent  Good  Average  Poor
Has student ever failed an academic subject in school? Yes No
          If yes, please explain:


            GENERAL INFORMATION

How did you hear about this school?
Reason for selecting this school:

Application must be filled out completely  before it can be processed. Application, Registration, and Testing Fees of $
must accompany Application and are not refundable. An interview with the parents and the student will be required before final
acceptance.









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