APPLICATION
FOR ADMISSION
P.O. Box 2104
Roanoke, VA 24009
540-345-1688
Applicant’s Full Name:_______________________________________________________________
Preferred Name:_____________________________________________________________________
Address (street address, city, state, zip)__________________________________________________ ___________________________________________________________________________________
Applicant’s Age: __ Gender:___ Home Phone:_________________________
E-mail: ____________________________________________________________
SSN: __________________ Date of Birth:___________________________
Name, Address and Phone number of School Last Attended: __________________
___________________________________________________________________
Number of Years at above School: _______________________________________
Present Grade:_______________________________________________________
Father’s Name: (Mr., Dr., etc.)
__________________________________________________________
First Last
Address:
___________________________________________________________________________
Father’s Employer:_______________________
Occupation:__________ Title:________
Email: ______________________________________ Home
Phone: (___)________
Business Phone:
(___)________ Mobile: (___)_________
Business Address (street, city, state,
zip): __________________________________________________
____________________________________________________________________________________
Mother’s Name: (Mrs., Dr., etc.)___________First__________________________ Last
Home Address (Street, city, State, Zip):
___________________________________________________
____________________________________________________________________________________
Mother’s Employer:_______________________Occupation:__________
Title:________
Email: ______________________________________
Home Phone: (___)________ Business Phone: (___)________ Mobile: (___)_________
Business Address (Street, city, state,
zip): _________________________________________________
___________________________________________________________________________________
Student Lives With: (Check all that apply)
Father______ Mother ______ Stepfather ______ Stepmother _____ Guardian _____
In an Emergency Contact: Name: _________________________Phone: (___)________
Applicant’s Siblings:
______________________Name___________Birth date____________________School
______________________Name___________Birth date____________________School
______________________Name___________Birth date____________________School
______________________Name___________Birth date____________________School
Relatives who have attended Community School/Community High School: _______________________________________________________________________
Relationship to Student:
________________________________________________________________________
Applicants should be aware that the curriculum requires a high degree of self-management. Some of the following information requested below may be used for program evaluation.
Please list all hobbies and interests:
List major cities you have visited in the United States and abroad:
List the books you have read for pleasure in the last year:
What do you like to do in your free time?
What adjectives would you use to describe yourself?
What qualities do you think a good teacher has?
How would you rate yourself as a student? Poor Good Very good Excellent
Rate your writing ability. Poor Good Very good Excellent
Rate your knowledge of history. Poor Good Very good Excellent
Rate your knowledge of mathematics: Poor Good Very good Excellent
Rate your knowledge of science/natural history: Poor Good Very good Excellent
Rate your knowledge of music, art, drama: Poor Good Very good Excellent
Do you have a particular interest in the arts? (For example – music, art, film, drama, photography, web design, yoga, dance) Tell us about your experiences and suggest how you hope to pursue your interest at CHS.
On a separate page please write a composition explaining
why you want to attend Community High School.
Include how a Community High education will benefit you, and how your
participation might benefit others. If
you dislike this topic, write an essay of your design which tells us a bit more
about who you are.
Financial Information (Please indicate person responsible for tuition and fees):
Name: ________________________________________________________________________
First Last
Home Address: _________________________________________________________________
Street City State Zip
Home Phone: ( ) ______ Business Phone: ( )_____________ Mobile: ( )____________
Community High School offers limited Tuition Assistance/Scholarship monies to families with demonstrated financial need. To apply for Tuition Assistance, please include a Statement of Financial Need and a copy of your latest Income Tax Form with this application. Tuition Assistance monies are awarded without regard to race, color, national or ethnic origin, sex or religion.
Please submit the following to Community High School for consideration for admission:
· Application form and an application fee of $25.00
·
Emergency Treatment form
·
Permission form
·
Authorization
for Release of Information form
·
Two letters of recommendations from those
familiar with your education.
· Transcripts from schools attended from 8th grade forward
· You may submit additional samples of your work—writings, artwork, photographs, videos, computer programs, graphics, etc.—with this form.
If you have questions regarding this application or Community High School, please call (540) 345-1688.