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STUDENT
APPLICATION FORM
On-campus Resident
Student
APPLICATION:
Complete all * Required
fields and click the "Submit" button at the bottom of
this form.
If you prefer
to mail us your application, click the "print" button
in the upper right corner of this page, complete the form and
mail it to:
Advent
Home Learning Center, Inc.
New Student Application
900 County Rd. 950
Calhoun, TN 37309
After
you submit this application, someone from our enrollment services staff will contact you
about the next steps in the application process.
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STUDENT
INFORMATION
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PARENT
/ GUARDIAN INFORMATION
(Mother and Father may also mean guardian of student)
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*
First Name
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FATHER'S
INFORMATION
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*
Middle Initial
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*
Relationship
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if "Relative"
if "Other"
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*
Last Name
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Social Security Number
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*
First Name
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*
Birth:
State
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*
Middle Initial |
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*
Birth:
City
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*
Last Name
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Birth:
County |
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*
Street Address
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Birth:
Country |
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Apartment/Unit
#
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*
Date of Birth
(month/day/year) |
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*
City
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Current Age |
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*
State
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*
Current Grade
Level Completed
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*
Zip Code
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*
Height (in feet and inches)
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Feet
Inches
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*
Father Email Address
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*
Weight (in lbs.)
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*
Home Phone
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*
Birthmark(s)
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Cell
Phone
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*
Tattoo / ID (marks and locations)
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*
Work Phone |
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Glasses
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Time
Zone
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Ethnicity
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*
Best
Time to Call
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Religious Preference
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Occupation
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Baptized |
If "Yes," what month, day & year?
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*
Highest
Education
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SOCIAL
HISTORY: In your judgement,
which of the following factors contributes
most to the potential student's issues?
Mark in order of priority: 1=most important, 6=least important
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MOTHER'S
INFORMATION
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*
Relationship
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if "Relative"
if "Other"
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*
Worldly
Music
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First Name
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Smoking/drinking
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Middle Initial |
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TV/Videos
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Last Name
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Divorce
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*
Street Address
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Adoption
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Apartment/Unit
#
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Finances
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*
City
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DIAGNOSIS:
Is the potential student
diagnosed with any of the following? |
*
State
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ADHD
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Zip Code
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ODD
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Mother Email Address
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Bi-Polar
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*
Home Phone
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Aspergers
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Cell Phone
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Terret
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Work Phone |
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Other
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Time
Zone
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*
Best
Time to Call
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*
Occupation
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*
Highest
Education
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| Revised
05/19/11 |
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