Date App Received Fee pd Ck/Cash Interview Date Time Staff Staff

Cornerstone Tutorial Center             
a homeschool resource 948 S. 91st East Ave.
Tulsa, Oklahoma 74112
918/664-9527
www.ctctulsa.org

2010-2011 Student Application

Please COMPLETE both sides of this application for EACH student you wish to enroll at CTC.
All applications are subject to approval by the CTC Board of Directors
(All new families will be called by the CTC office to schedule an interview before registering for classes.
A $15 APPLICATION FEE per new student will be due prior to the family interview.)
Student's Preferred Name: 2009-2010 CTC Student?
If you are a new student, please list who referred you to CTC:
Grade in 10-11: Current Age: Date of birth: Will student be driving
on campus?
Caucasian   Native American   African American   Asian   Other:
Address (street, city, state, zip):
Home phone: Parent's email address:
Father: Wk phone: Cell:
Occupation: Employer:
Mother: Wk phone: Cell:
Occupation: Employer:
Church: Member how long?
Reference (non-family): Relationship: Phone:
Reference: Relationship: Phone:

School History:
School G R A D E   L E V E L Public or Private School Names
Type 3rd 4th 5th 6th 7th 8th 9th 10th 11th
Public                    
Private                    
Home                    
Is this student currently (or ever been) dismissed or suspended from any educational facility?
Has this student's application been denied by any educational facility?

Other Children (not attending CTC):
Name Age 10-11 Grade School Name
       
       
       
       
       
~ PLEASE COMPLETE PAGE 2 ~
Describe your expected “in-home” education plan (non-CTC classes) for the 2010-2011 academic year.
Course Curriculum Teacher
     
     
     
     
     

List the courses/subjects this student is interested in taking at CTC:
Course/Subject Tues. Wed. Thurs.
       
       
       
       
       
       

Describe any special medical needs:
 

Describe any special learning needs:
 
Describe your reasons and expectations for enrolling this student at CTC:
 
 

CTC is a tutorial center, not a school. We do not have the time, resources or mandate to constantly supervise and discipline students. We are structured to assist families who are committed to the concepts of Christian self-government and home schooling. This means that students are responsible for their own behavior and learning under guidance of a parent or tutor. Please rate this student’s ability and willingness to function in such an environment using the scale of 1=high, 2=average, 3=low.
Area Rating Area Rating
Shows respect to and for authority   Works quietly and independently  
Listens to and obeys instructions   Resists negative peer pressure  
Completes assignments on time   Willing to follow rules and regulations  
Prompt (student will avoid excessive absences and tardiness ----------------------------------------  
Comments or any other helpful information:
 
 

I (We) certify that the above information is true and correct.

                                                                                                                                                                   
Parent's Signature                                                                                                     Date

Submit completed application by mail (948 South 91st East Ave.), fax (664-9542), or email (ctcacademic@cox.net). After application is received, the CTC office will schedule the family interview. $15 application fee per NEW STUDENT is due prior to the family interview.