Date App Received

Fee pd

Ck/Cash

Interview date

Time

Staff

Staff

CORNERSTONE TUTORIAL CENTER                              

a home school resource                                                                                                                     948 S. 91st East Ave.

                                                                                                                                                                Tulsa, Oklahoma 74112

                                                                                                                                                                918/664-9527

                                                                                                                                                                www.ctctulsa.org

2008-2009 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:

2007-2008 CTC Student?

If you are a new student, please list who referred you to CTC:

Grade in 08-09:

Current age:

Date of birth:

Will student be driving on campus?

Caucasian

 

Native American

 

African American

 

Asian

 

Other:

Address (street, city, state, zipcode):

Home phone:

Parent’s email address:

Father:

SS#:

Wk phone:

Cell:

Occupation:

Employer:

Mother:

SS#:

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

’08-’09 Grade

School Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TURN OVER TO COMPLETE OTHER SIDE (OR COMPLETE PAGE 2)

 

 

 

Describe your expected “in-home” education plan (non-CTC classes) for the 2008-2009 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 and I (We) authorize CTC to conduct a credit search from my credit bureau report to obtain information needed to complete my application.

_____________________________________________________________________________________

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.