Home School Academic Partnership Program Application Application also available online at www.WesternMennoniteSchool.org/homeschool
Step 1 ☐ Application Received
STUDENT INFORMATION
☐ Male ☐ Female
Student name:
Date:
Applying to enter the 20 ☐6
☐7
☐8
☐9
- 20
☐ 11
Upon acceptance into the Homeschool Academic Partnership Program the following registration documents must be completed.
☐ 12
FAMILY INFORMATION Father: Lives with student: ☐ Yes ☐ No
☐ Contact and Insurance Information form
Email: Home Phone: Address:
☐ Community Standards Agreement
Cell Phone: Street
Date: Step 2
school year in grade:
☐ 10
OFFICE USE
City
State
Zip
Mother: Lives with student: ☐ Yes ☐ No
☐ Pastor/Mentor reference ☐ Adult friend 1 reference
Email: Home Phone:
Cell Phone:
Address: Do you have any unique learning needs?
☐ Internet and Technology Use Policy Agreement
☐ Adult friend 2 reference ☐ Attach current photo here:
☐ Yes ☐ No
If yes, please explain:
What Classes are you interested in? (see attached list of classes) *Home school students can take a maximum of two classes per semester* Priority 1:
Priority 4:
Priority 2:
Priority 5:
Priority 3:
Priority 6:
Class availability based on enrollment and teacher schedules. You will be contacted regarding the availability of the classes you list above.
Western Mennonite School admits qualified students of any race, color, nationality or ethnicity.
[APPLICATION] Western Mennonite School REFERENCES Please list name, complete address, and phone number of an adult in each category who knows you well. Do not list immediate family members. Give each reference the attached form, or direct them to the online reference form at www.WesternMennoniteSchool.org/references Pastor or mentor: Name: Address:
Email: Street
City
State
Zip
Phone:
Adult friend 1: Name: Address:
Email: Street
City
State
Zip
Phone:
Adult friend 2: Name: Address:
Email: Street
City
State
Zip
Phone:
Western Mennonite School Covenant for Disciples Western Mennonite School does not require its students to have a personal commitment to God as a condition for admission; however, we do require that students sign the Covenant for Disciples every year to encourage growth and maturity. COVENANT FOR DISCIPLES. To grow in mind: We will apply ourselves to learn from classroom and other school activities, and to fill our time and minds with what is wholesome and worthwhile, avoiding any speech, social conduct, or personal appearance which is degrading or disrespectful. To grow in body: We will apply ourselves to a pattern of proper diet and sufficient rest and exercise, abstaining from the use of tobacco, alcohol, and illegal drugs. To grow in spirit: We will be open to the influence of Jesus Christ and His followers in our lives, and be an encouragement, rather than hindrance to those who want to grow in an obedient relationship to Him. To grow in character: We will be trustworthy in all of our relationships, respecting the rights and property of others, speaking and living the truth in all circumstances.
I declare that to the best of my knowledge and belief that the information provided on this application is true and complete. Student Signature:
Date:
Parent/Guardian Signature:
Date:
Please mail or deliver your completed application to the Western Mennonite School Admissions Department
CHARACTER REFERENCE FORM Form also available online at www.WesternMennoniteSchool.org/references Part 1: To be completed by the applicant Name of applicant: Home phone
Date: Current grade: Email:
Part 2: To be completed by reference Your name:
Relationship to student:
How long have you known this student: Home address: Street
City
Home phone
State
Zip
Email:
Circle the words which best describe this student: joyful friendly rebellious flexible creative
vivacious easy-going procrastinates responsible prompt
Please rate the following: Academic ability Social adjustment to peers Attitude toward authority Family support Christian commitment Leadership
loud neat proud loyal leader
loving quiet tolerant dramatic active
Very High
forgiving articulate lethargic organized shy
High
cheerful spiritual defensive studious
Average
devoted congenial humble flexible
Low
sociable follower clown sincere
Very Low
meek careless tender troubled
Unknown
What special talents, skills, or leadership qualities would this student bring to Western Mennonite School?
In what areas of personality and performance would you like to see growth? Do you recommend this student for acceptance at Western?
Yes
No
Why? Please add any additional comments which might be helpful. Signature: ___________________________________________________ Date: Please return to: ADMISSIONS, WESTERN MENNONITE SCHOOL 9045 Wallace Rd NW, Salem, OR 97304
THANK YOU FOR YOUR TIME AND CARE ALL RESPONSES WILL BE KEPT CONFIDENTIAL
CHARACTER REFERENCE FORM Form also available online at www.WesternMennoniteSchool.org/references Part 1: To be completed by the applicant Name of applicant: Home phone
Date: Current grade: Email:
Part 2: To be completed by reference Your name:
Relationship to student:
How long have you known this student: Home address: Street
City
Home phone
State
Zip
Email:
Circle the words which best describe this student: joyful friendly rebellious flexible creative
vivacious easy-going procrastinates responsible prompt
Please rate the following: Academic ability Social adjustment to peers Attitude toward authority Family support Christian commitment Leadership
loud neat proud loyal leader
loving quiet tolerant dramatic active
Very High
forgiving articulate lethargic organized shy
High
cheerful spiritual defensive studious
Average
devoted congenial humble flexible
Low
sociable follower clown sincere
Very Low
meek careless tender troubled
Unknown
What special talents, skills, or leadership qualities would this student bring to Western Mennonite School?
In what areas of personality and performance would you like to see growth? Do you recommend this student for acceptance at Western?
Yes
No
Why? Please add any additional comments which might be helpful. Signature: ___________________________________________________ Date: Please return to: ADMISSIONS, WESTERN MENNONITE SCHOOL 9045 Wallace Rd NW, Salem, OR 97304
THANK YOU FOR YOUR TIME AND CARE ALL RESPONSES WILL BE KEPT CONFIDENTIAL
CHARACTER REFERENCE FORM Form also available online at www.WesternMennoniteSchool.org/references Part 1: To be completed by the applicant Name of applicant: Home phone
Date: Current grade: Email:
Part 2: To be completed by reference Your name:
Relationship to student:
How long have you known this student: Home address: Street
City
Home phone
State
Zip
Email:
Circle the words which best describe this student: joyful friendly rebellious flexible creative
vivacious easy-going procrastinates responsible prompt
Please rate the following: Academic ability Social adjustment to peers Attitude toward authority Family support Christian commitment Leadership
loud neat proud loyal leader
loving quiet tolerant dramatic active
Very High
forgiving articulate lethargic organized shy
High
cheerful spiritual defensive studious
Average
devoted congenial humble flexible
Low
sociable follower clown sincere
Very Low
meek careless tender troubled
Unknown
What special talents, skills, or leadership qualities would this student bring to Western Mennonite School?
In what areas of personality and performance would you like to see growth? Do you recommend this student for acceptance at Western?
Yes
No
Why? Please add any additional comments which might be helpful. Signature: ___________________________________________________ Date: Please return to: ADMISSIONS, WESTERN MENNONITE SCHOOL 9045 Wallace Rd NW, Salem, OR 97304
THANK YOU FOR YOUR TIME AND CARE ALL RESPONSES WILL BE KEPT CONFIDENTIAL