Call Our Office: 270-753-7744

New Student Application Form

Please fill out this form completely. If you prefer to fill out this form by hand, please download and print our static New Student Application Form.

First Name
?
Enter the first name of student applying.
Last Name
?
Enter the last name of student applying.
Middle Name
?
If student does not have a middle name, enter "NA"
Students Social Security Number
Home Address
City
State
Zip
Phone
Date of Birth
?
(dd/mm/yyyy)
Gender
Birthplace
Grade Entering
Previous Grade
Father's (or Male Guardian's) Full Name
Occupation
Employer
Work Address
Work Phone
Cell Phone
Primary Email Address
Mother’s (or Female Guardian’s) Name
Occupation
Employer
Work Address
Work Phone
Cell Phone
Primary Email Address
Emergency Contact (Other Than Parent)
Emergency Contact's Phone Number
Family Status
If the child is not living with both parents, please explain with whom he lives.
Names of brothers and sisters attending Eastwood Christian Academy.
Church Affiliation
Has the student ever been expelled?
Has the student ever been retained? If yes, please indicate below.
Last School Attended
Address
Grade Last Year
Has the student ever attended Eastwood Christian Academy?
If the student has had any academic difficulties in school thus far, please explain.
Condition of Health
If you answered ‘Physical Disabilities’ above, please explain.
Has the student ever had any incidents with the law, or does he have a police record?
If you answered ‘Yes’ above, please explain.
Is the student a United States citizen?
Please state the reasons why you wish for this student to attend Eastwood Christian Academy.
How Did You Hear About ECA?


Contact info
Our Location

2191 State Route 94 East
Murray, Kentucky 42071

How To Contact Us

Email: info@ecamurray.org
Phone: 270.753.7744
Fax: 270.753.5721

Office Hours

Monday-Friday: 8:00am - 3:30pm
Wednesday: 8:00am - 1:30pm



Eastwood Baptist Church
Eastwood Baptist Church

Eastwood Christian Academy is a ministry of Eastwood Baptist Church
Andy Harrell - Pastor
Murray, Kentucky

www.ebcmurray.org
Phone: 270.753.1834

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© 2017 Eastwood Christian Academy

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