International Boarding Student Application Checklist · Application Checklist Admission Checklist – Submit all Admission forms to [email protected] or mail to the Admissions

1 Office of Admissions The King’s Academy 202 Smothers Road Seymour, TN 37865 U.S.A. Phone: 1-877-378-1880 Fax: 865-573-8323 [email protected]

International Boarding Student

Application Checklist

Admission Checklist – Submit all Admission forms to [email protected] or mail to the Admissions

Office at the academy address.

Online Application or Paper Application

Application Fee $50.00

o Pay by credit card using the International Application Fee Form

o Pay by wire transfer using Peer Transfer

www.thekingsacademy.peertransfer.com

Student Questionnaire Supplement

Official Transcripts Translated into English (Please submit the Permission to Release Student Records Form to

the student’s current school.)

Official English Proficiency Test Scores

The Office of Admissions will contact the student references and request they complete School Reference Forms

(See Page 10)

Interview (Skype)

The Academy will send an Acceptance Decision Letter

o Priority Dates: Applicants who submit applications by February 15 for the subsequent school year will

receive notification of an acceptance decision by March 10.

o If the applicant is accepted, enrollment instructions will be given.

mailto:[email protected]

http://www.thekingsacademy.peertransfer.com/


The King’s Academy

202 Smothers Rd.

Seymour, TN 37865

865-573-8321

[email protected]

Boarding Student Application

Student Name: ________________________________________ Academic Year: _______________ Grade: ________

Applicant Information

Full Name: ______________________________________________________________________________

Nickname: __________________________________ Birth Date: ____________________

Street Address: __________________________________________________ City: ____________________

State/Province: _________________ Zip: _______________ Country: _______________________________

Email Address: ___________________________________________________________________________

Home Phone: _________________________ Cell Phone: ________________ Student Gender: M F

Student Ethnicity: _____________________________ Student Citizenship: ___________________________

Primary Language Spoken at Home: _________________________ Birth City: ________________________

Birth State: __________________ Birth Country: __________________________

How did you hear about us? ________________________________________________________________

Please tell us why you are applying to The King’s Academy.

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

When do you plan to begin attending The King’s Academy? Please state the month and year. _____________

Dual Citizenship Country (if applicable): ________________________________________________________

Is the student a permanent resident of the United States? Yes No

If you are a permanent resident: Please provide a copy of the student’s permanent resident card. What is

your alien registration (green card) number? _______________________________________

What is your alien registration (green card) expiration date? _____________________________

If you are not a permanent resident: Are you applying for an F-1 (student) visa? Yes No

Are you currently attending a school in the United States? Yes No

Have you ever viewed The King’s Academy Facebook Page? Yes No

Have you ever seen the King’s Academy on Twitter? Yes No



Previous Schools Most Recent/Previous School Attended

School Name: ____________________________________________________________________________

Street Address: ___________________________________________________________________________

City: ______________________________ State: _________ Zip: ______________ Phone: ______________

From Date: ________________________ To Date: _______________________ Grade Completed: ________

Second Most Recent/Previous School Attended

School Name: ____________________________________________________________________________

Street Address: ___________________________________________________________________________

City: ______________________________ State: _________ Zip: ______________ Phone: ______________

From Date: ________________________ To Date: _______________________ Grade Completed: ________

Has the applicant ever been dismissed or suspended from school? Yes No If yes, please explain:

________________________________________________________________________________________

________________________________________________________________________________________

Has the applicant ever had incidents of school truancy? Yes No If yes, please explain:

________________________________________________________________________________________

________________________________________________________________________________________

Religious Affiliation

Religious Affiliation: ________________________ Current Place of Worship: __________________________

Phone: ______________________ City: ____________________________ State: ________ Zip: _________

Pastor: _______________________________________________________ Church Member? Yes No

Is the applicant a Christian? Yes No

Please discuss the applicant’s involvement in church (if applicable): __________________________________

________________________________________________________________________________________

________________________________________________________________________________________


Additional Student Information

Does the applicant have any disability, impairment, or condition that may represent a health or safety risk for

the student or others, or which should or may restrict the student’s activity? Yes No If yes, please explain:

________________________________________________________________________________________

________________________________________________________________________________________

Has the applicant ever been diagnosed by a qualified professional to have a medical or emotional condition

that requires continuous medication? Yes No If yes, please describe the condition: __________________

________________________________________________________________________________________

________________________________________________________________________________________

Please list all prescribed medications, dosages, and reasons for taking.

________________________________________________________________________________________

________________________________________________________________________________________

Has the student every received an educational, psychological or “504” evaluation, or an individualized

educational plan (IEP), or has the student ever been referred, or qualified for special education services?

Yes No If yes, please explain. Send a scanned copy of test results to [email protected]

or mail a copy to the Office of Admissions.

________________________________________________________________________________________

________________________________________________________________________________________

Have you suspected that a learning handicap condition exists? Yes No If yes, please explain:

________________________________________________________________________________________

________________________________________________________________________________________

Has the applicant ever skipped a grade? Yes No If yes, what grade was skipped? ___________________

Has the applicant ever been tested for a gifted program? Yes No

Has the applicant ever been retained? Yes No If yes, what grade was repeated? _________________

Please list the student’s involvement in co-curricular activities (sports, music, art, drama, etc.)

________________________________________________________________________________________

________________________________________________________________________________________

Please discuss the applicant’s attitude toward and history of the following (add an explanation if needed):

Tobacco: ________________________________________________________________________________

Alcohol: _________________________________________________________________________________

Other Drugs: _____________________________________________________________________________



Has the applicant had any serious illnesses, serious injuries, hospitalizations and operations including

rehabilitation admissions and chemical dependency or behavioral treatment programs? Yes No

If yes, please explain and include dates and types of admissions: ____________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Has the applicant ever had any instances of theft? Yes No If yes, please explain: ____________________

________________________________________________________________________________________

Has the applicant had any incidents of fighting? Yes No If yes, please explain: ______________________

________________________________________________________________________________________

Has the applicant ever had any involvement with legal authorities? Yes No If yes, please explain:

________________________________________________________________________________________

________________________________________________________________________________________

Has the applicant ever been referred to or received the services of a professional counselor? Yes No

If yes, please explain: ______________________________________________________________________

________________________________________________________________________________________


Household 1 Please answer the following questions about the applicant’s Primary Family or Custodial Household.

Parents who reside at two different addresses: Please fill out the enrollment responsible parent’s information ONLY below.

Home Address

Street Address: ___________________________________________________________________________

City: ________________________________________ State: ___________ Zip: _____________

Country: _____________________ Home Phone: _________________

Parent/Guardian One Parent/Guardian Two

Last Name

First Name

Middle Name

Suffix

Salutation

Gender

Relationship to Applicant

Custodial Rights? Yes No Yes No

Financial Responsibility? Yes No Yes No

Receive Correspondence? Yes No Yes No

Marital Status

Email 1

Email 2

Work Phone

Cell Phone

Occupation

Employer

Employer City

Employer Zip

Current Church

Highest Level of Education

Degree


Does the applicant have a parent/guardian that lives at another address? Yes No If yes, please answer

the following questions about the Secondary Family or Custodial Household. If no, please skip to Siblings.

Household 2

Home Address

Street Address: ___________________________________________________________________________

City: ________________________________________ State: ___________ Zip: _____________

Country: _____________________ Home Phone: _________________

Parent/Guardian One Parent/Guardian Two

Last Name

First Name

Middle Name

Suffix

Salutation

Gender

Relationship to Applicant

Custodial Rights? Yes No Yes No

Financial Responsibility? Yes No Yes No

Receive Correspondence? Yes No Yes No

Marital Status

Email 1

Email 2

Work Phone

Cell Phone

Occupation

Employer

Employer City

Employer Zip

Current Church

Highest Level of Education

Degree


Siblings

Sibling 1

Sibling Name: _____________________________________ Age: __________ Date of Birth: _______________________

Grade: __________ Current School: _____________________________________________________________________

Sibling 2



Sibling 3



Alumni or Currently Enrolled Students

Does the applicant have any other relatives who currently attend, have attended, or have graduated from The

King’s Academy? Yes No If yes, who? _____________________________________________________

Statements of Commitment

When an applicant is accepted, a deposit is required and is payable through the online enrollment system. This deposit constitutes evidence of good faith in binding this agreement and can apply to the student's account. I understand that such deposits, except for deposits for international students applying for student visas, are non-refundable after one month prior to the school term for which the student is applying.

I understand that, in the event the student withdraws enrollment or is dismissed from the Academy during the course of a school year, tuition for the complete current grading period is due, payable, and will not be refunded. Students whose accounts are more than 60 days past due are subject to dismissal. Accounts must be current before the student will be permitted to participate in designated co-curricular activities or take semester exams, and before student records will be released.

Parent Signature: ___________________________________________________ Date: _________________

I understand the philosophy and purpose of The King's Academy. I understand that the Academy is a distinctively Christian school. As such, its students are expected to pattern their life-styles after the model of Jesus Christ. Academy students who may not be personally committed to Jesus Christ are strongly encouraged by the Academy to make this commitment. I understand that the Academy forbids the use of tobacco, alcoholic beverages, and other non-prescribed controlled substances. I also understand that cheating, lying or the violation of any criminal or civil law shall be construed as a violation of Academy policy. I understand that these Academy rules apply both on and off campus, and that Academy students are expected to uphold the standards of the Academy at all times and in all places. I certify that the statements made in this enrollment packet are true and complete to the best of my knowledge. I also understand that falsification, withholding pertinent information, or failure to comply with Academy regulations may result in dismissal.



Statement of Faith

The academy affirms and teaches:

The Holy Bible as the inspired, infallible, authoritative word of God.

There is one God, eternally existent in three persons: Father, Son and Holy Spirit.

The deity of the Lord Jesus Christ, His virgin birth, His sinless life, His miracles, his vicarious and atoning death through His shed blood, His bodily resurrection, His ascension to the right hand of the Father and His personal return in power and glory.

For salvation of los and sinful man, regeneration by the Holy Spirit is absolutely essential.

The present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life.

The resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation.

The spiritual unity of believers in the Lord Jesus Christ.



Applicant References

1. Please list the Name, Title, Phone, and E-mail for the following references for this applicant. 2. The Office of Admissions will contact each person and ask them to complete a reference form and send

it back to the Office of Admissions.

Principal/Guidance Counselor

Name

Title

Phone Number

Email Address

English Teacher

Name Title Phone Number Email Address

Math Teacher


Family Friend


Minister/Christian Leader (if applicable)



Statements of Commitment

When an applicant is accepted, a $15,000 deposit is required. This deposit constitutes evidence of good faith in binding this agreement and will apply to the student's account. I understand that such deposits, except for deposits for international students applying for student visas, are non-refundable after one month prior to the school term for which the student is applying.

I understand that, in the event the student withdraws enrollment or is dismissed from the Academy during the course of a school year, tuition for the complete current grading period is due, payable, and will not be refunded. Students whose accounts are more than 60 days past due are subject to dismissal. Accounts must be current before the student will be permitted to participate in designated co-curricular activities or take semester exams, and before student records will be released.


I understand the philosophy and purpose of The King's Academy. I understand that the Academy is a distinctively Christian school. As such, its students are expected to pattern their life-styles after the model of Jesus Christ. Academy students who may not be personally committed to Jesus Christ are strongly encouraged by the Academy to make this commitment. I understand that the Academy forbids the use of tobacco, alcoholic beverages, and other non-prescribed controlled substances. I also understand that cheating, lying or the violation of any criminal or civil law shall be construed as a violation of Academy policy. I understand that these Academy rules apply both on and off campus, and that Academy students are expected to uphold the standards of the Academy at all times and in all places. I certify that the statements made in this enrollment packet are true and complete to the best of my knowledge. I also understand that falsification, withholding pertinent information, or failure to comply with Academy regulations may result in dismissal.


Statement of Affirmation

I certify that the statements made in this application packet are true and complete to the best of my knowledge. I also understand that falsification, withholding pertinent information, or failure to comply with Academy regulations may result in termination of enrollment.


Release of Records

I waive my right to access confidential information contained in my child’s admission file.




202 Smothers Road

Seymour, TN 37865-5056

Telephone: 865-573-8321 Fax: 865-573-8323

[email protected]

Application for Admission

Student Questionnaire Supplement

(To be completed by the student in his or her own handwriting and returned by fax or email.)

Name _____________________________________________________ Date______________

Please answer the questions below as completely as possible.

Please check the statement that best describes your understanding of Christianity.

__ I am a Christian. (Start with question 1.)

__ I know something about Christianity, but I would not say that I am a Christian. (Skip to question 3.)

__ I do not know anything about Christianity. (Skip to Question 3.)

1. A. Discuss your experience in your relationship with Christ.

B. Discuss how your Christian commitment would relate to your role as a student at The King’s Academy.

2. A. With which denomination are you affiliated?

B. How long have you had this affiliation?

C. Is this your family’s religious affiliation?

D. To what extent are you involved or an active participant?



3. A. With which religious group are you affiliated, if any?

B. How long have you had this affiliation?

C. Is this your family’s religious affiliation?

D. To what extent are you involved or an active participant?

4. The King’s Academy is a Christian university preparatory school. This means that the rigorous academic

curriculum is taught from a Biblical worldview and all academy students are required to take Bible classes (one class

per year) and participate in weekly chapel on campus. All boarding students attend weekly church services on

Sunday mornings. Academy students who may not be personally committed to Jesus Christ are strongly encouraged

by the Academy to make this commitment.

A. If you attend The King’s Academy, will you be open to learning about Christianity?

B. If you attend The King’s Academy, will you be willing to uphold the Christian standards of the academy?

5. Why do you wish to attend The King’s Academy? Explain if you are applying at the request of someone else.

6. In what activities do you participate with your church, school or community?

7. What has been your involvement with tobacco, alcohol or other drugs?

8. Discuss your academic strengths and weaknesses. What subjects do you enjoy most and which ones do you like

least?

9. Where do you want to be and what do you want to be doing ten years from now?



INTERNATIONAL APPLICATION FEE FORM

Please complete and return this form to the Office of Admissions if you prefer to pay the application

fee by credit card.

Student Name: ______________________________________ Term Enrollment: ☐Fall ☐Spring

Date of Birth: ____________________ Year of Enrollment: __________

Gender: ☐ Male ☐ Female

PERSON RESPONSIBLE FOR PAYMENT OF ACCOUNT: ☐Parent ☐Guardian

Name: __________________________________________ Telephone: ______________________________

Address: ________________________________________________________________________________

_____________________________________________________ Country: ___________________________

Email address: ____________________________________________________________________________

Parent/Guardian Signature: __________________________________________________________________

TO PAY BY CREDIT CARD: ☐VISA ☐MASTER CARD

Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Amount: __US$50.00________

3 - Digit Authorization Code: __________ Expiration Date:___/___/___

Name on Card: ___________________________________________________________________________

Signature Required: _______________________________________________________________________

FOR OFFICE ONLY:

Application Fee Amount: ___US$50.00____________ Date Received: ___/___/___

Treasurer’s Signature: ______________________________________________________________________

Application fee is not refundable. Please email a scanned copy of the completed form to

[email protected] or fax to 865-579-1184. Thank you.


Permission for School to Release Student Records

Note: Please forward to previous school official and request that official transcripts be

mailed to The King’s Academy.

Name of Applicant ______________________________________________

The above named student is applying for admission to The King’s Academy,

Seymour, Tennessee.

In order for the application to be considered, I authorize the release of my child’s

records as requested by The King’s Academy. Please include all cumulative academic

and social records, test scores, and medical and immunization records.

Please send to: Admissions Office


202 Smothers Rd.

Seymour, TN 37865-5056

U.S.A.

_________________________________________________ ______________________

Signature of Parent or Guardian Date

Documents

International Boarding Student Application Checklist · Application Checklist Admission Checklist – Submit all Admission forms to [email protected] or mail to the Admissions