Summer School & Course Credit Recovery Application

Student Information
Student’s First Name*
Student's Middle Name
Student's Last Name*
Students Date Of Birth*
MM slash DD slash YYYY
Gender*
- Female
- Male
Last Grade Completed*
Current Grade*
Please enter any pertinent information concerning your child and his/her educational needs
Course Requested:

Current School Information
Current School Enrolled*
Address*
City State
Race/Ethnicity*
- American Indian or Alaskan Native
- Asian
- Black or African American
- Hispanic or Latino
- Native Hawaiian or Pacific Islander
- White
- Other
Have you ever been previously enrolled in Christian Academy of America?*
- Yes
- No

Curriculum Preference
Program Preference*
- Workbook
- Online
Tuition for a half credit course allows for students to take up to 6 months. One or more credits allow students to take up to 12 months to complete courses.
Do you need credit for this course by a certain date?*
- Yes
- No
Date credit is needed.*
MM slash DD slash YYYY

We have reviewed the Student Application and to the best of our knowledge, all information provided is complete and accurate. We understand that a credit recovery or summer school student is not considered to be on the full-time active student roll of Christian Academy of America. We understand that our child is to be under direct adult supervision during coursework time and that the supervising adult has read and understands the Academy policies and procedures as set forth in the Academy Handbook of Instructions. We agree that the supervising adult will submit our responses to the Academy's Required Response Forms that are sent to us via email. We further understand that the supervising adult will require that the student adhere to the Academy procedures, including, but not exclusive of, copying answers from the Score Keys or Test Keys and by keeping the Test Keys in a secure location, or any Program Abuse (cheating). By entering our names in the Signature boxes, We understand and agree with the above statements and also verify the information entered is correct to the best of our knowledge.
Student's Signature*
Father / Guardian Signature*
Mother / Guardian Signature*
Name of Parent, Guardian, or Supervisor responsible to administer this home school program:
If this is a person other than the Parent or Guardian, please provide the relationship to the student:
Payment Details
Registration*
- $75 (1st - 8th Grade)
- $95 (9th - 12th Grade)
Please reenter student's name.
First Last
Total
$0.00
Today's Date
MM slash DD slash YYYY
Credit Card
Card Details
Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Individual Course Application

Student Information

Current School Information

Parent/Guardian Information

Curriculum Preference

Payment Details

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