VictoryChristianAcademy
1719 Broadway
Mount Vernon, Illinois62864
618-241-0427
Fax: 618-242-6650
vca1988.org
Thank you for your interest inVictoryChristianAcademy.Victory is a school committed to excellence in every area of endeavor. Our mission is to produce graduates who possess a Christian worldview and walk out that worldview in every area of life.
Founded in 1988 with grades 1-5, VictoryChristianAcademy has continued to expand. Serving grades K5-12, Victory offers a student-centered, high-tech learning environment. Grades three through 12 utilize an individualized program using a computer-based curriculum.
At VictoryChristianAcademy we strive to produce Christian graduates whose gifts, talents and abilities are developed to the fullest possible extent in order to allow those graduates to fulfill the unique call of God on their lives.
We believe that God is placing a definite call upon the lives of young people to become involved at Victory where, guided by a committed teaching staff, these young people will achieve their great potential. If you have not had an opportunity to visit our campus, we would encourage you to do so at the first opportune time. Meanwhile, we will be in prayer with you regarding God's will and direction for your family.
In His Service,
D. H. Olivier, M.A., Doctoral Candidate
Administrator
New Student Enrollment Procedure[Statement of Nondiscrimination] VictoryChristianAcademy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at school. It does not discriminate on the basis of race, color, national or ethnic origin.
Once you make a decision to seek enrollment at VictoryChristianAcademy, the following information will be helpful:
- Review the material found in your new student application packet.
- Obtain and complete a New Student Enrollment Application one per family.
- Complete a Student Admissions Application for each student being enrolled. It is necessary to complete all information prior to submitting the application for review, including the church membership statement.
- Secure Pastor’s reference letter for students applying for grades K12 and Former Teacher’s reference for students applying for grades 3-12 (provided in packet).
- Complete the information requested on the Student Health Record.
- Sign the Parent/Student Questionnaire.
- Read and sign the Parental Agreement (One form per family). This agreement will be in effect for as long as the family has students enrolled at Victory.
- Return New Student Enrollment Application and Student Admissions Applications to the school registrar along with $75 per student enrollment fee. This is a nonrefundable fee payable at the time application is made. A student may only be officially enrolled after this fee is paid.
- You will be called for an interview.
At the time of the interview, a copy of the student's transcripts and/or last report card will be required. As part of the interview process, students in grades 5 12 will be presented with the Honor Pledge and be asked to sign it. This pledge will be in effect for as long as a student is enrolled in VCA.
Diagnostic tests will be administered to students. Final grade placement will be determined by the school once all information is received.
VictoryChristianAcademyNew Student EnrollmentComplete one New Student Enrollment Application per family. This form must be returned along with the Student Admissions Application to the School Registrar.
Students Applying for Enrollment (list oldest first)Last Name / First Name / Birthday / Grade In Fall
NOTE: Please complete a Student Admissions Application for each new student being enrolled. A copy of the birth certificate and immunization record must accompany this application form.
Current Home Phone: / Work Phone Father:Work Phone Mother:
What is the name of the church your family is currently attending?
Your signature is verification that the information contained on this form is correct.
Signature of mother (guardian) / Date
Signature of father (guardian) / Date
Office Use Only
Acct No: / Enrollment Date:
Date notification sent to parent: Med. Consent Form:
Questionnaire: / Application: / School records:
Enrollment Fees Paid: / Immunization: / Tuition Paid:
References: / Agreement form: / Physical:
VictoryChristianAcademyParent/Student Questionnaire
This questionnaire is to be completed after reading the Parent Manual. Completion of this questionnaire is required for enrollment. When possible, we recommend parents and students read the manual together. Parents may complete this form for kindergarten and 1st grade students. Please return this form to the school office as soon as possible.
Questions / Family Member / Yes / No1. Have you read the Victory Christian Academy Parent Manual? / Student
Parent
2. Are you in agreement with this vision? / Student
Parent
3. Are you regular in church attendance? / Student
Parent
4. Are you a faithful tither? / Student
Parent
5. Will you commit to a daily devotional time with your family? / Student
Parent
6. Parents, will you work with the teachers by assisting your children with their homework, class projects? Students, will you do your homework? / Student
Parent
7. Will you uphold the standards of the school in your home? / Student
Parent
8. Will you as parents commit to attending all Parent/Teacher Conferences?
Parent
9. As a student, do you want to be at VCA? / Student
Father’s Signature / Date
Mother’s Signature / Date
Student’s Signature / Date
Student’s Signature / Date
Student’s Signature / Date
Student’s Signature / Date
Victory Christian Academy Student Application
Admissions Application K-12
Note: This application does not assure final enrollment but provides information upon which a decision will be based. A non-refundable enrollment fee must accompany this application. The enrollment fee is necessary for the student to be considered for enrollment. If you are on the class list and we have no room in a grade, we will refund the fee. A copy of the birth certificate and immunization record must accompany this application . VictoryChristianAcademy reserves the right to alter class selection based on final enrollment.
Since records are filed separately, an application is needed for each student.
A. NONDISCRIMINATION POLICY:VictoryChristianAcademy admits students of any race, color, nationality, and ethnic origin to all rights, privileges, programs, and activities made available to students at the school. It does not discriminate on the basis of race, color, nationality, age, gender or ethnic origin in administration of its education policies, admissions policies, athletic, and other school administered programs.
B. GENERAL RECORD. / New Student / Former Student Last Year attended ____
Student:______
(Last Name) (First Name) (Middle Name)
Application for Grade: ______/ Gender: Male Female / Date of Birth: ______
Month Day Year
Address: Apt # / House #: Street Name: P.O. Box/RR#:
City: / State: / Zip: Country:
Resides with: (Circle One) / Mother/Father
Guardian / Mother Only
Father/Stepmother / Father Only
Mother/Stepfather
Title: (Circle One) / Mr. & Mrs. Mrs.
Dr. & Mrs. Dr. / Ms. Mr.
Drs. Rev.&Mrs. / Rev.
Student Social Security Number: US Citizen: Yes No Country:
Mother/Guardian: (First Name/Last Name) SS#:
Father/Guardian: (First Name/Last Name) SS#:
Current Home Phone: / Email Address:
Emergency Contact Name (other than parent): / Emergency Phone Number:
Relationship of Contact / Comments:
Doctor’s Name: / Doctor’s Phone:
Hospital to be taken to in case of an emergency:
Mother’s Employer: Work Phone:
Father’s Employer: Work Phone:
Self-Employed: (Type of Business)
OFFICE USE ONLY Student ID#
Date Received / Grade / Acct Clear / Auth Med. / Birth Cert. / Interview & Honor code
Names of persons authorized to pick up student other than parents / Relationship / Phone Number
Was this student ever denied admission to a private or Christian school? If so, why?
Was this student ever suspended or expelled from school? If so, when and why?
Name of last school attended: / Phone Number:
C. FINANCIAL RECORD
Do you owe tuition at any other Christian school? If so, please explain.
Are there any reasons why you would be unable to pay your tuition on time? If so, please explain.
D. CHILD’S SPIRITUAL RECORD
Church Name:
Address:
Denomination: / Senior Pastor:
Name of Children/Youth Pastors:
Church family attends:
Year you accepted Jesus Christ as Lord and Savior: Year you were water baptized:
Are your parent(s) active member(s) of your church?
Do you attend one church service per week at your church?
Are you involved in any areas of ministry? If so, please explain.
E. PARENT QUESTIONNAIRE: (Attach additional sheets if necessary.)
Why do you want to send your child to VictoryChristianAcademy?
What are your child’s greatest strengths?
What are your child’s greatest needs in the following areas?
Spiritual
Behavioral
Social
Emotional
In what ways have you had to be of assistance in helping your child achieve academically?
Has your child experienced any behavioral, academic, physical, or emotional challenges that have required special services from a therapist, psychologist, medical doctor, or other specialist? If yes, please explain.
Is your child currently diagnosed with any learning or health condition? If yes, please explain.
Has your child ever been involved with the juvenile authorities? If so, please explain.
F. STUDENT QUESTIONNAIRE (Grades 5-12) To be completed by the student.
Have you used drugs, alcoholic beverages, or used tobacco within the last 12 months? If yes, please explain.
Have you been sexually active? If yes, please explain.
Have you ever had to appear in juvenile court? If yes, please explain.
What are your favorite subjects?
What subjects will you need the most help with?
Why do you feel that you should be accepted as a student at VictoryChristianAcademy?
What are some goals that you have for your life?
Whose idea is it for you to attend VictoryChristianAcademy?
What behaviors and attitudes will you have to work at changing to become a quality student at VictoryChristianAcademy?
What one thing do you wish to avoid at VictoryChristianAcademy that you were unable to avoid in your last school?
AFFIRMATION:
I hereby affirm that all of the information contained in this application is true and accurate to the best of my knowledge. I understand that providing any false information would be sufficient reason for the rejection of this application or suspension when found out. I further understand that I may be asked for additional written affirmation concerning such items as academic record and health records.
Student Signature / Date / Signature of Father (Guardian) / Date
VictoryChristianAcademy,1719 Broadway / Signature of Mother / Date
Mt. Vernon, Il 62864, 619-242-4396;
VictoryChristianAcademyLetter of Reference-Pastor
Personal Recommendation for Applicant
(Grades K-12)
Recommendation must be received for the application to be complete
Applicants First Name: / Middle: / Last:
Address: / City: / State/Zip:
INSTRUCTIONS TO APPLICANT: After completing the spaces below, give this form to your minister, along with a stamped envelope addressed to Registrar, VictoryChristianAcademy. Please sign the following waiver form: I the undersigned, hereby voluntarily waive any right or privilege provided by Public Law 93-380 to inspect or challenge the content and comments expressed in this “Personal Recommendation for Applicant.”
Date: / Signature of Student (or Parent if student is under 19):
INSTRUCTIONS TO MINISTER: Please complete this form carefully and prayerfully, and mail it directly to the school as soon as possible. Since we expect straightforward comments, we will treat all information as strictly confidential. We appreciate you assistance.
1. How long have you known the applicant?
2. Comment on the applicant’s spiritual, behavioral, and social life.
3. Describe the applicant’s home life: (Include information about the spiritual and moral leadership of the parents, relationships among members of the family, etc).
4. To the best of your knowledge has the applicant accepted Jesus Christ as personal Savior?
5. Does the applicant respond well to authorities in the home, church, and school?
6. Are you aware of any physical weakness or emotional problems that would hinder the applicant in an intensive academic environment?
7. What are the applicant’s special abilities?
8. What do you believe is the applicant’s primary purpose in attending VictoryChristianAcademy?
Please respond to the following check list. Place a mark next to one item in each grouping.
Motivation / Responsibility / Integrity / Acceptance by Others
Highly motivated / Conscientiously reliable / Consistently trustworthy / Highly respected by others
Usually purposeful / Usually dependable / Usually honest / Liked by others
Aimless / Irresponsible / Frequently dishonest / Avoided by others
No opportunity to observe / No opportunity to observe / No opportunity to observe / No opportunity to observe
Student for Grades 5-12 Only
1. In what ways has the applicant been active in church?
2. To the best of your knowledge, what is the applicant’s attitude toward such practices as smoking and use of alcoholic beverages or drugs?
3. To the best of your knowledge, has this student been sexually active?
4. Has the applicant’s life given evidence of a genuine conversion and subsequent growth toward spiritual maturity? (Please comment.)
5. To the best of your knowledge has the applicant ever been suspended from school?
6. To the best of your knowledge has the applicant ever been in trouble with the law?
7. To the best of your knowledge does the applicant use profanity?
8. What do you feel will be the applicants greatest challenge in adjusting to a 24 hour disciplined life style that is God honoring?
9. In your opinion is the applicant able and willing to put forth the extra effort to be a model student?
FINAL RECOMMENDATION FOR ALL GRADES
Would you recommend that VictoryChristianAcademyaccept this applicant?
No Questionable Yes Strongly Recommend
Signature / Area Code Phone Number
Street Address
City / State / Zip
Occupation / Date
Mail recommendation to VictoryChristianAcademy, 1719 Broadway, Mt. Vernon, Illinois62864
VictoryChristianAcademy Letter of Reference-TeacherPersonal Recommendation for Applicant
(Grades 3-12)
Recommendation must be received for the application to be complete
Applicants First Name: / Middle: / Last:
Address: / City: / State/Zip:
INSTRUCTIONS TO APPLICANT: After completing the spaces below, give this form to your minister, along with a stamped envelope addressed to Registrar, VictoryChristianAcademy. Please sign the following waiver form: I the undersigned, hereby voluntarily waive any right or privilege provided by Public Law 93-380 to inspect or challenge the content and comments expressed in this “Personal Recommendation for Applicant.”
Date: / Signature of Student (or Parent if student is under 19):
INSTRUCTIONS TO TEACHER: Please complete this form carefully and mail it directly to the school as soon as possible. Since we expect straightforward comments, we will treat all information as strictly confidential. We appreciate you assistance.
1. How long have you known the applicant?
2. Comment on the applicant’s behavioral and social life.
3. Describe the applicant’s home life to the best of your knowledge.
4. Does the applicant respond well to authorities in the home and school?
5. Are you aware of any physical weakness or emotional problems that would hinder the applicant in an intensive academic environment?
6. What are the applicant’s special abilities?
7. What do you believe is the applicant’s primary purpose in attending VictoryChristianAcademy?
Please respond to the following check list. Place a mark next to one item in each grouping.
Motivation / Responsibility / Integrity / Acceptance by Others
Highly motivated / Conscientiously reliable / Consistently trustworthy / Highly respected by others
Usually purposeful / Usually dependable / Usually honest / Liked by others
Aimless / Irresponsible / Frequently dishonest / Avoided by others
No opportunity to observe / No opportunity to observe / No opportunity to observe / No opportunity to observe
Student for Grades 5-12 Only
1. To the best of your knowledge, what is the applicant’s attitude toward such practices as smoking and use of alcoholic beverages or drugs?
2. To the best of your knowledge, has this student been sexually active?
3. To the best of your knowledge has the applicant ever been suspended from school?
4. To the best of your knowledge has the applicant ever been in trouble with the law?
5. To the best of your knowledge does the applicant use profanity?
6. In your opinion is the applicant able and willing to put forth the extra effort to be a model student?
FINAL RECOMMENDATION FOR ALL GRADES
Would you recommend that VictoryChristianAcademyaccept this applicant?
No Questionable Yes Strongly Recommend
Signature / Area Code Phone Number
Street Address
City / State / Zip
Occupation / Date
Mail recommendation to VictoryChristianAcademy, 1719 Broadway, Mt. Vernon, Illinois62864
VictoryChristianAcademyStudent Record ReleaseMAIL TO:
Office of the Registrar
VictoryChristianAcademy
1719 Broadway
Mt. Vernon, Il 62864
Fax: 618-242-6650
I give my permission to release all school records including, cumulative records, immunization records, birth certificate, medical, behavioral and academic records and standardized testing records to the above school.Full Legal Name of Student:
Birth date: / Grade:
School Last Attended:
Street Address:
City: / State: / Zip:
School Phone Number: School FAX Number:
I understand that my child will be enrolled on a conditional basis at VictoryChristianAcademy until the records are received. I further understand that my child may be found ineligible for enrollment based on information obtained from the school from the student’s record. I certify that the information provided above is true to the best of my knowledge.
Signature of parent/guardian: Date:
School Use Only (To be Completed by SendingSchool)
1. Has this student ever been suspended from school?
2. Is student currently serving a suspension or expulsion?
3. If yes to either of these questions, describe reason for suspension or expulsion and when the suspension or expulsion took place and/or will end.
Name of person completing this section:
VictoryChristianAcademy Use Only
Date request mailed/faxed: / Date records received:
Records complete: / Comments:
VictoryChristianAcademy Enrollment Parent Agreement
Tuition Payment
Since the school has a financial obligation to its employees, students are considered enrolled for the entire school year. Tuition is calculated on the basis of the entire year; therefore, no reductions can be made for vacations or school holidays. If a student enters after the school year has begun, charges are prorated according to actual number of days enrolled. No deductions will be made for tuition during the school year, regardless of the cause of such absence. All accounts must be paid in full at the end of each quarter to receive report cards.