Application for Admission, Page 1
Parent Information:
Father's Full Name:
Mother's Full Name:
Address:
Home Phone: - -
Primary Email Address:
Father's Employer: Bus. Phone: - -
Mother's Employer: Bus. Phone: - -
Marital Status:




Student(s) live with:



School District of Residence:
Student Information:
Student #1:
Student's Full Name: Birth Date: / /
Birth Certificate #: Age: years old

Entering Grade: School attended last year:
Reason for Leaving last School:
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Has this student even been suspended for disciplinary reasons?
Has this student ever been expelled from school?
Does this student have any physical, emotional, learning, or mental disability, which may impact his or her ability to function in school?
(if yes, please explain)
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Student #2:
Student's Full Name: Birth Date: / /
Birth Certificate #: Age: years old

Entering Grade: School attended last year:
        

Jubilee Christian School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs


Jubilee Christian School ~ 255 Washington Road, Mt. Lebanon, PA 15216  
Phone: 412-561-5917  ~  Fax: 412-561-2857
E-Mail: judi.phelps@jubileechristianschool.org