Valley Harvest Ministries - VHCS Application

Valley Harvest Christian School

Student Application

Prior to completing your application, you may go ahead and pay the application fee(s) by clicking one of the following options:

IMPORTANT REMINDER: An separate application will need to be completed for each child you would like considered for enrollment.

Having trouble submitting the electronic application? Print the PDF to complete and mail!

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Student Information

Student's Full Name (First, Middle and Last)

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Age

Birthdate

Gender

Male

Female

Birthplace

School Last Attended

Address of Last School Attended:

Last Grade Completed

Family Information

Father's Full Name (First, Middle, and Last)

Father's Employer

Father's Role with Employer

Father's Business Phone Number

Father's Email Address

Mother's Full Name (First, Middle, and Last)

Mother's Employer

Mother's Role with Employer

Mother's Business Phone Number

Mother's Email Address

Marital Status

Single

Married

Divorced

Separated

Additional Emergency Contact (If parents/guardians cannot be reached)

Emergency Contact Phone Number

Other children in the family of school age (if they are not also applying to the school):

Reason they are not applying:

Faith Information

Name of the church your family attends:

Church's Address

Church's Phone Number

Pastor's Name

Pastor's Phone Number

Is the student's father a Christian?

Yes

No

Is the student's mother a Christian?

Yes

No

Has the student ever made a profession of faith in Christ?

Yes

No

Medical Information

Student's Physician

Physician's Address

Physician's Phone Number

Does the student have any medical issues, physical defeats, or allergies that school staff need to be aware of? If so, please explain:

Scholastic Information

Has the applicant ever been expelled, suspended, or been refused admission to another school?

Yes

No

If the applicant has been expelled, suspended or been refused admission, please explain:

Has the applicant ever had disciplinary difficulty at school?

Yes

No

If the applicant has ever had disciplinary difficulty at school, please explain:

Does the applicant have a juvenile or arrest record?

Yes

No

If the applicant has an arrest record, please explain:

Has the applicant ever used tobacco or nonprescription drugs of any kind?

Yes

No

Choice Three

If the applicant has ever used tobacco or nonprescription drugs of any kind, please explain:

Please indicate the academic level of the applicant's previous work

Excellent

Good

Average

Poor

Has the applicant ever failed an academic subject in school?

Yes

No

If yes, what subject(s)?

General Information

How did you hear about our school?

What was your reasoning behind selecting our school?

Did you pay the application fee online?

Yes

No

If not, how do you plan to pay?

Check/cash in person at the church/school (1 Harvest Place, Dublin, VA 24084)

Check/cash via mail (P.O. Box 458, Dublin, VA 24084)

Submitting the Application

THE APPLICATION MUST BE FILLED OUT COMPLETELY BEFORE IT WILL BE PROCESSED. THE APPLICATION FEE MUST ACCOMPANY THE APPLICATION AND IS NON-REFUNDABLE. AN INTERVIEW WITH THE PARENTS AND THE APPLICANT WILL BE REQUIRED BEFORE FINAL ACCEPTANCE.

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