Grace Lutheran School

1815 East 9800 South--Sandy, Utah 84092

801.572.3793--Fax: 801.553.2403
Internet: www.GraceSandy.org email: school@GraceSandy.org

Application must be received with $40.00 non-refundable application fee.

APPLICATION FORM
Is the student: OFFICE USE: Date received: Fee:

Member of Grace Lutheran Church
Enr.
Tuition
Fees
Data
Class

Sibling of a student enrolled at WAIT LIST SPACE NOTIF: ______
INTERVIEW: ACCEPT/NOT ACCEPT

STUDENT INFORMATION
Student's full name:
Male Student attends church?
Yes
No

Female
Name preferred by child: If yes, where?
Date of birth: Grade/Class applying for:
Is student baptized?
Yes
No

School year applying for: If yes, name of church: Date:

Home phone #:
Home address: Home email:
Student lives with:
City: State: Zip:
Both parents
Mother

Guardian:_____________
Father

PARENT INFORMATION
FATHER or
Guardian
Stepfather MOTHER or
Guardian
Stepmother

First name Last name Title First name Last name Title

Home address (if different from student's) Home phone Home address (if different from student's) Home phone:

Email: Email:

Employer or business name Occupation Employer or business name Occupation

Work phone: Cell phone: Work phone: Cell phone:

Married
Divorced
Married
Divorced

Separated
Remarried
Separated
Remarried

Widowed
Widowed
FAMILY INFORMATION
Brother(s) & Sister(s) Names Age Grade School Attending
 ENROLLMENT

Why are you considering our school?

How did you hear about Grace Lutheran School?

EDUCATIONAL BACKGROUND
List schools applicant has attended in the past:
School Name Grade(s) Dates Attended

Answer YES or NO to the following questions:

Has student repeated a grade?
Yes
No Received tutoring?
Yes
No

Participated in a special learning program?
Yes
No Currently on medication? (indicate below)
Yes
No
Participated in a gifted program?
Yes
No Received special honors/awards?
Yes
No
Experienced learning difficulties in reading?
Yes
No Experienced learning difficulties in math
Yes
No
Experienced discipline problems?
Yes
No Ever suspended?
Yes
No

Please comment about any of your responses:

ADDITIONAL STUDENT INFORMATION (PLEASE COMMENT)

Educational maturity:

Social maturity and personality:

Physical health (include any allergies/restrictions):

Any needs or concerns the school should be aware of:

Any custody issues the school should be aware of:

X Parent signature: Date: