ACS Online Registration:

1.
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Student Last Name

2.
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Student First Name

3.
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Student Middle Name

4.
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Gender

5.
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Date of Birth

6.
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Street Address (Apt #)

7.
*

City

8.
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State or Country

9.
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Zip Code

10.
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Name of Current School

11.
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Student resides with

12.
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Mother/Guardian: First Name/Last Name

13.
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Phone number of Mother/Guardian

14.
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Father/Guardian: First Name/Last Name

15.
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Phone number of Father/Guardian

16.
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US Citizen

17.
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Student ethnicity

African American   Asian or Pacific Islander
Caucasian   Hispanic
Native American   Oriental
18.
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Has this student ever been denied admission to a private Christian School? If "yes", why?

19.
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Name of church currently attending

20.
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Are your parents active members of your church?

Yes
No
21.
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Year student accepted Jesus Christ as Lord and Savior. If this has not occurred, enter "None".

22.
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What are your favorite subjects in school?

23.
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In which subjects will you need the most help?

24.

I would like more information regarding ACS Online classes. Please contact me.

by phone
by email
25.

I am interested in enrolling in the following online classes. Please contact me so I can enroll.

Course                            Grade Level
   
   
   
   
   

        

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