Skip Navigation

Request Information

Antioch Christian Academy is unable to provide services and teaching for students who receive IEPs, accommodations, or more individualized teaching due to the lack of resources and expertise needed to help these students achieve academic success.

Thank you for your interest in our school!

Please fill out the form below and our Admissions Office will contact you and provide the information you desire.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us?
    Details:

  • Mother Employed By

  • Mother Position

  • Father Employed By

  • Father Position

  • Marital Status
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
  • Email Address
    Confirm Email Address
  • Grade Level of Interest *
    School Year *
  • Student Interests
    Sports
  • Current School

  • Year

  • Grade Completed

  • Current/Last School Address

  • Academic Level at previous school 

  • Has this child ever been retained? 
    Yes   No

  • Grade

  • Ever suspended/expelled? 
    Yes   No

  • Grade

  • (If YES Explain)

  • Ever refused admission to another school?
    Yes   No

  • Explain

  • Any disciplinary difficulties
    Yes   No

  • Explain
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •