FORM A

Please answer all questions as completely as possible.

PART 1 - REGISTRATION INFORMATION
I am applying for:
I am applying for Grade: 9 10 11 12
I will be a: New Student Re-entry Student
I will be: Living in a student residence Living at home and commuting to school
Have you applied to attend CHS before? Yes No

PART 2- PERSONAL INFORMATION
Prefix: Mr   Ms
First Name: Legal Last Name:
Middle Name: Permanent Mailing Address:
City: Province/State
Postal/Zip Code: Country
Home Phone -- Work Phone --
Fax Number -- Fax Location: Home Parent's Work
Other:  
Parent's Email Address: Email Location: Your address Family's address
Other:  
Student's Email Address:
Social Insurance / Security Number:
Date of Birth (mm/dd/yy):
Citizenship: Canadian US Other: 

FAMILY INFORMATION
Father's Name: Address:  Same as above or: 
Phone Number: Occupation:
Mother's Name: Address:  Same as above or: 
Phone Number: Occupation:
Would your parents like to be on our mailing list?   Yes No
Have you had any relatives attend CHS, Briercrest College or Briercrest Seminary?
Mother Father Brother(s)/Sister(s) Cousin(s) Aunt(s)/Uncle(s) Grandparent(s)

With whom do you live?
Who has legal custody of you?
What was the main factor that influenced you to apply to CHS?
Have you visited the campus of CHS? Yes No
If Yes, when or for what event did you visit the campus?

CHURCH and ALUMNI INFORMATION
Do you presently attend church? Yes No If Yes, what church?
Denomination of church: Pastor's name:
Church address: City:
Province/State: Postal/Zip Code:
Phone Number: Fax Number:
How long have you attended this church? How often to you attend?
What events or activities are you involved in at this church?
Do your parents attend the same church?   Yes No
Do your parents attend regularly?   Yes No

EDUCATION INFORMATION

What schools have you attended? (Mandatory)

Grade Name of School(s) Type(s) City, Province/State Dates
8 Public Private Home
ACE Standard Curriculum
9 Public Private Home
ACE Standard Curriculum
10 Public Private Home
ACE Standard Curriculum
11 Public Private Home
ACE Standard Curriculum
12 Public Private Home
ACE Standard Curriculum
Have you ever repeated a grade? Yes No If yes, which grade?
Have you ever been expelled /
dismissed from school?
Yes No If yes, for how long?
State circumstances:

PERSONAL TESTIMONY
Please share your personal testimony with us. Include the details of your acceptance of Christ, how you are currently growing in your relationship with Him, significant changes in your life, any ministry (summer/camp missions, church involvement, etc.) you have been involved with, and anything else you would like to share with us. The application will not be reviewed without submission of this personal testimony.


 PAYMENT INFORMATION (OPTIONAL)

You can choose to submit your application fee online by entering in your credit card information below.
The application fee is $100 ($150 for international applications).

Name as on Card
Card Type
Card Number
Expiry Date:

SSL