Application for Admission
Mission Statement
To grow children in the truth of God's word and His love for them.
12 Academy
9300 S Anderson Rd
Oklahoma City, OK 73165
Phone: 405-312-0325 Email: 12academy226@gmail.com
www.12academyschool.com
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FEES DUE WITH APPLICATION
A $100.00 Application Fee and a $100.00 Curriculum Fee (both non-refundable, total $200.00) must accompany this application.
Fall
Spring
of school year
applying for grade
Applicant's Name
First Name
Middle Initial
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE
Format: (000) 000-0000.
DATE OF BIRTH
-
Month
-
Day
Year
Date
Gender
MALE
FEMALE
Ethnic background (OPTIONAL for demographic reporting purposes):
African-American
Hispanic
Caucasian
Asian
American Indian/Alaska Native
Native Hawaiian/Pacific Islander
Two or more races
Applicant lives with (check all that apply):
Mother
Father
Legal Guardian
Stepmother
Stepfather
Other
Applicant's Parent (s):
Married
Separated
Divorced
Deceased
If divorced, which spouse holds legal responsibility for school decisions?
(Please submit copies of all court documents regarding custody and educational decisions along with the application.)
Current Church
FATHER'S INFORMATION
Title
Dr.
Mr.
Other
Relationship to Applicant
Father
Stepfather
Legal Guardian
Parent/Guardian
First Name
Middle Initial
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Position
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
MOTHER'S INFORMATION
Title
Dr.
Mrs.
Ms.
Other
Relationship to Applicant
Mother
Stepmother
Legal Guardian
Parent/Guardian
First Name
Middle Initial
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Position
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
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The two factors most influencing us to apply to 12 Academy (please circle only two):
The two factors most influencing us to apply to 12 Academy (please circle only two):
Academic Reputation
Christian Philosophy
Desire to Attend a Private school
Displeasure with Local Schools
Location
Is this applicant eligible to return to his/her current school?
Yes
No
Has your child ever been suspended from any school or asked to leave?
Yes
No
Please explain:
I/We hereby authorize 12 Academy to obtain all scholastic information and files from all previous schools.
Yes
No
Has the applicant received special help for reading or learning difficulty?
Yes
No
Has the applicant been diagnosed with ADD or ADHD?
Yes
No
Is the applicant presently taking any medication?
Yes
No
If yes, what?
Describe any illness, diseases, or physical disabilities that either have affected or may affect your child's general health, school work or participation in the school's physical wellness programs. Are there currently any behavioral, psychological or educational evaluations, treatments, or interventions?
Please include your parental perspective on your child. Include your child's strengths and abilities, special interests, areas of concern and his/her relationship with God. We appreciate your assistance in helping us to know your child better.
Grandparents' Name(s) and Complete Address(es) including first and last names and zip code(s)
Parent/Guardian Signature:
Date:
-
Month
-
Day
Year
Date
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Enrollment Fee
$100.00
$
100.00
Quantity
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Curriculum Fee
$100.00
$
100.00
Quantity
1
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10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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