Date of Last Upload: Monday, May 15, 2023 Student Enrollment Form

   New Student Information
Select the Submit Application tab after you have filled in all information including students, primary and secondary family, and emergency/contacts. Use the tab buttons to select the pages to fill in the information. Required fields are bold.

Student 1

*Last Name*First NameMiddle NamePreferred Name*Date of Birth (mm/dd/yyyy)SuffixTitleChurch AffiliationGenderRaceE-Mail*Grade LevelGrade CompletedStudent Health InformationCheck if any apply 1Check if any apply 2Check if any apply 3List any AllergiesOther AllergiesList any SurgeriesList other health info
Schools AttendedSchoolGradesCity StateDates Attended
With whom will this student reside?If the student does not reside with both father and mother, or if the student has been adopted, or is the subject of any court ordered relationship, please explain the child's legal status fully below. Please furnish a photocopy of adoption or other court order affecting the student.Student ResidesExplain legal status of child
Why do you wish to enroll your student in FCA?Why attend FCAWere you referred to FCA by someone?Referral