PRESCHOOL through Kindergarten
Please print this page and turn it in to the school office.
Child’s Name _________________________________________________________
Last First Middle Name Used
Current Grade____________ Grade applying for________ Male___ Female___
Date of Birth ______________ Present Address _____________________________
Home Phone _________________ ________________________________
Mother’s Work Ph. ___________________ Father’s Work Ph. __________________
Mother’s Cell Ph. ____________________ Father’s Cell Ph. ____________________
Other Numbers __________________________________________________________
Other emergency names and phone numbers _________________________________
Relationship to your child _________________________________________________
Please complete the following information, understanding that it will be confidential. Your child is very precious to us; and therefore, it is our desire to meet his/her needs to the best of our ability. The information below will enable us to better understand your child. Thank you for helping us.
Name _________________________ Married/Single/Divorced
Profession _____________________ e-mail address(es):
Firm Name ____________________ ____________________________
Education Level _______________ ____________________________
Name ________________________ Married/Single/Divorced
Profession ____________________ e-mail address(es):
Firm Name ___________________ _____________________________
Education Level _______________ _____________________________
School applicant is attending or last attended ___________________________________
School Name School District
School Address City State Zip Code Phone
Was this a positive school experience for your child? ____________________________
Has your child ever been retained? _______Yes ______No
Has your child ever had difficulty in reading or math? ____________________________
Has your child ever been diagnosed for or received special help for a reading or learning difficulty? ______Yes ______No
Please circle the answer that best describes your evaluation of your child.
Academically do you consider your child: above average average below average
In peer relationships do you consider your child: above average average below average
Does he/she make friends easily? ______Yes ______No
Emotionally do your consider your child: above average average below average
How does your child relate to you as the parent?
overly dependent overly independent comfortably
How would you are your child’s obedience to you on a scale of 1-10?
(10 being very obedient)
1 2 3 4 5 6 7 8 9 10
How well does your child respond to other authority figures? (Grandparents, Sunday School Teachers)
compliant reluctant defiant
On a scale of 1 - 10 how does your child feel about school?
(10 being enjoys/looks forward to school)
1 2 3 4 5 6 7 8 9 10
Does your child have any specific habits? (thumb sucking, nail biting, hand washing, teeth grinding, snapping) _______________________________________________________________________
Siblings: (names and ages)__________________________________________________
How does your child relate to siblings? __________________________________
What other adults live in your home? _________________________________________
With whom does your child stay when mother/father is away? _____________________
Right/Left Handed _________
Favorite toys: ___________________________________________________________
Special talents/interests: ___________________________________________________
How often does your child watch TV/videos? __________________________________
What is your child’s favorite TV program/video? _______________________________
Does your child sit and listen to stories? ___________________ Like books? _________
What kind? _____________________________________________________________
Can your child read? _________________ If not, does he/she show interest? _________
Does your child enjoy music/singing? ________________ Types of music? __________
Pets? (names/kind) _______________________________________________________
Does your child attend Sunday School? _____________ Where? ___________________
Any other activities outside the home? ____________________________________
What is your child’s favorite color? ________ Number? ________ Game? _______
What are some experiences which have influenced your child (trips, illnesses, accidents, moves, job loss, deaths, divorce, etc.)? _____________________________________
Does your child have a daily routine and how does he/she react to changes in routine?
Does your child need help going to the bathroom? Explain _____________________
What are some chores/responsibilities your child has around the house?
Should we be made aware of anything which frightens your child?
How do you discipline your child?
What is his/her reaction to your discipline?
Have you detected or suspected difficulties in hearing? _____ speech? _____ sight? ____
How did you first learn of NCA? (check only one)
___Student(s) currently enrolled ___Alumni ___Newspaper or magazine
___ Minister ___Parents of NCA student ___Telephone book ____Online search
Did you explore our website? ____Yes ____No
Are you an NCA Facebook fan? ____Yes ____No
What most influenced you to apply to NCA?
___Academic Reputation ___Christian Worldview ___Location ___Teaching Staff
___Recommendation of NCA families ___Desire to attend a private school
What school district do you currently reside in? (circle one)
Nacogdoches: TJR Brooks-Quinn Jones Raguet Fredonia
Nettie Marshall Carpenter Mike Moses McMichael
Douglass Martinsville Woden San Augustine Lufkin
Central Heights Cushing Central Chireno Etoile
Thank you for sharing this information about your child. Please use the rest of this sheet, and the back if you need it, to tell us anything else you want us to know about your child. Is your child imaginative, artistic, talkative, temperamental, jealous, independent, happy, etc.?