New Student Application

Vine Academy

2023 - 2024 School Year

Student Name *

Student Birth Date *

Student Entering Grade Level *

Primary Phone Number *

List here the number we should first contact if we have any questions.

Physical Address (student's primary address) *

Apt, suite, etc.

Country

City

State

Zip code

Mother's Name *

Mother's Cell Phone

Mother's Email *

Father's Name *

Father's Cell Phone

Father's Email *

Our Mission:

Vine Academy is a Christian organization that is a unique fusion of “home & schooling.” Vine’s educational premise is: At Vine, we believe that parents are responsible for their children’s education, spiritual development, and character under God’s guidance. Vine’s purpose is to come alongside you as parents to assist in your endeavor to educate your students to become godly men and women.

About Your Family

How did you hear about Vine Academy? *

Describe your family's philosophy of education (Please include why you are choosing to homeschool, if both parents are in favor of enrollment at Vine, and why you are changing they way your child is currently being schooled) *

Why would you like your child to attend Vine? *

Have you been part of a home-schooling group or ISP? *

If yes, which one(s)?

How long do you plan to homeschool your child? *

For example: We plan to homeschool (name of student) until he/she enters into high school. At that time, we will enroll our child in a private school.

What schools/educational option(s) has your child been a part of in past years? *

Share any stresses or circumstances that would affect your child’s learning environment (ex. new baby, new job, illness in the family): *

Do you attend a church? If so, how often do you attend and where do you attend? *

About Your Student

Does your child want to attend Vine? How do they feel about entering into a classroom environment? *

Please write a brief appraisal of your student’s character qualities, and maturity level (both strengths and weaknesses). *

How does your child handle conflict at home? Has your child been corrected for behavioral difficulties by another school or program? *

Describe your student’s study habbits; are they self-motivated, easily distracted, or other? Please describe: *

About Your Students Grade Level (Click all that apply): *

student has had academic testing

Your student is at grade level in all core subjects

Your student is above grade level in all or some subjects

Your student is below grade level in all or some subjects

Please explain:

Does your student have any physical, emotional, behavioral or special needs? If yes, please explain: *

Does your student attends church regularly, if so, where? *

Describe ministries in which your student is currently involved, type in "none" if they are not in a ministry: *

About You as a Parent

Marital Status *

If Divorced, Do you have:

Sole Custody

Shared Custody

Describe your commitments outside of work and traditional home schooling (ex. ministries, co-ops, sports, side jobs). *

Parental Support: *

Vine’s classes are taught 2 & 3 days per week. You will be expected to teach your student on the days they are home and to help meet any needs that arise at Vine. Will it be difficult for you to be able to provide the time needed for the parental support? Please answer "yes" or "no" and give a brief discription or explanation.

Services Hours: *

Family involvement is necessary for the success of Vine. Please check that you understand a minimum of 20 hours (or 30 hours if more than one student per family attends Vine) of services which will include one big event (Science Fair, Masquerade Party, or similar), per family, for Vine are required to be served before the final day of the school year. Service / volunteer hours are to be served by a Vine Parent or responsible adult. (A list of service needs will be provided). You may opt out by paying $20.00 per hour for each hour missed.

I agree that I or a responsible adult will serve a minimum of 20(30 for more than one student) hours or pay $20.00 per hour (per student) before the last billing cycle of the school year.

Are you interested and available to teach at Vine? If so, what are you passionate about and how have you used your gift teaching in the past? Are you willing to provide references? *

I have read and agree to Vine Academy's "STATEMENT OF FAITH" *

Statement of Faith can be found on our web site: http://vineacademy.net/wp/studentresources/forms/vines-statement-of-faith/

I Agree

I Disagree

Please list the best days and times both parents/guardians are available to meet for a family interview *

We would like to thank whoever referred you to Vine. Were you referred by anyone and if so, who?

Please let us know any thoughts, concerns, or questions you might have:

I hereby request enrollment of my child listed above as a student in Vine Academy. I agree to pay all fees and fulfill all requirements of enrollment.

I certify the above information is truthful, complete and accurate.

Signature *

Reset Signature

Signature is required.

Please type your full name and hit submit at the bottom of this page. I understand that this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *

Date *

FROM YOUR STUDENT

Please have your student complete this portion of the application.

Do you want to attend Vine? Why or why not? *

Tell us about yourself: what are your strengths, your interests, things your are involved in, etc.? *

Do you have a relationship with God? Please explain: *

How do you think Vine might be able to help you develop (educationally, socially, spiritually)? *