Application Packet

All Saints’ Episcopal School prepares students

for their future academic, moral, social, and

physical endeavors in a culturally diverse,

intellectually challenging, Christian environment.

All Saints’ Episcopal School does not discriminate

on the basis of race, color, creed, or national or ethnic

origin in the administration of its admission and

education policies, tuition assistance programs,

athletic programs, and/or any other school

administered activities.

_____________________________________________________________________________________________________________

3275 Maple Valley Road * Morristown, TN 37813 * (423) 586-3280 * Fax (423) 586-9355

www.allsaintsepiscopalschool.org

Application Date Received: ___________________

School Year 2010-2011 Time Received: ___________________

APPLICANT INFORMATION

______________________________________________________________________________________________________________

Last Name First Name Middle Name Preferred Name/Nickname

__________________________________________________________________________________________________________________________________________

Birth Date Age Social Security Number Gender

Incoming Grade:

□ 2-Day 2’s □ 3-Day 2’s □ 5-Day 2’s □ 3-Day 3’s □ 5-Day 3’s □ 3-Day 4’s □ 5-Day 4’s

□ Half-Day Kindergarten □Full-Day Kindergarten □ 1st □ 2nd □ 3rd □ 4th □ 5th □ 6th □ 7th □ 8th

□ Parents Divorced □ Parents Separated □ Father Deceased □ Mother Deceased If Divorced, Who Has Legal Custody?

PARENT/GUARDIAN INFORMATION

Father/Guardian Mother/Guardian
□Mr. □Dr. □Rev. □Hon. _____________________________ □Mrs. □Ms. □Dr. □Rev. □Hon. ______________________________

Relationship __________________________________ _______ Relationship _____________________________________________

Preferred Name _______________________________________ Preferred Name __________________________________________

Social Security Number ________________________________ Social Security Number ___________________________________

Street Address ________________________________________ Street Address ___________________________________________

City, State, Zip ______________________________ _________ City, State, Zip ___________________________________________

County ______________________________________________ County __________________________________________________

E-Mail Address _______________________________________ E-Mail Address ____________________________________________

Employer ____________________________________________ Employer _________________________________________________

Occupation/Title ______________________________________ Occupation/Title __________________________________________

Employer’s Address ____________________________________ Employer’s Address _______________________________________

City, State, Zip ________________________________________ City, State, Zip ___________________________________________

Home Phone __________________________________________ Home Phone _____________________________________________

Cell Phone ___________________________________________ Cell Phone _______________________________________________

Business Phone _______________________________________ Business Phone ___________________________________________

_________________________________________________________________________________________

3275 Maple Valley Road * Morristown, TN 37813 * (423) 586-3280 * Fax (423) 586-9355

www.allsaintsepiscopalschool.org

Applicant Name: ______________________

Incoming Grade: _______________________

EMERGENCY CONTACT & MEDICAL INFORMATION

Person, other than parent, authorized to act for parent in an emergency:
Name		Relationship		Address
Home Phone	Cell Phone		Employer		Business Phone

Name of Physician _______________________________________ Phone Number ___________________________________

Name of Dentist _________________________________________ Phone Number ___________________________________

Does Your Child Need to Take Medication at School? □ Yes □ No

Is Your Child Allergic to Anything of Which You Are Aware? □ Yes □ No

If “Yes”, Please List Allergies: __________________________________________________________________________________

TRANSPORTATION RELEASE

To ensure the safety of your child, please list other adults to whom your child may be released or who are authorized to provide transportation for your child.

Name ____________________________ Relationship _________________ Phone ______________

GENERAL INFORMATION

Child’s Religion/Denomination _____________________________ Place of Worship ___________________________________

Hobbies & Interests ___________________________________________________________________________________________

Sibling Name ______________________ Age _____ Present School ________________________ Applying to ASES Grade _____

How did you hear about All Saints’ Episcopal School? □ ASES Parent □ Newspaper □ Internet □ Other _____________

Has Any Other Member of Your Family Previously Attended All Saints’ Episcopal School? □Yes □ No

If “Yes”, please list below:

Name ___________________________________________ Relationship _________________ Year(s) Attended ________________

Paternal Grandparents’ Names __________________________ Maternal Grandparents’ Names __________________________

Address ______________________________________________ Address ______________________________________________

City, State, Zip ________________________________________ City, State, Zip ________________________________________

Publicity

Unless a letter to the contrary is received by the Head of School, enrollment in All Saints' Episcopal School gives the school administration permission to use your son’s/daughter’s picture on the official school web site and in newspaper advertisements or other publications. Permission to include the student’s and his/her parents’ names, address and phone numbers in the school directory, which will be distributed only to other All Saints' Episcopal School families, is also assumed.

Applicant Name: _________________________

Incoming Grade: _________________________

SIBLING INFORMATION

Name ______________________ Age ____ Present School ________________________ Applying to ASES Grade _____

SCHOOL INFORMATION

Applicant’s Current School ________________________________________________ Present Grade ___________

Address of School _______________________________________________________________________________________________

Street City State Zip Phone # Fax #

Name of Teacher _________________________________________________________________________________

Has your child ever received Special Educations Services? □ Yes □ No

If Yes, Please Explain ______________________________________________________________________________

Application Checklist

Your application is complete only when we have received the following:

□ A completed application for admission including a signed enrollment agreement.

□ A copy of your child’s most recent report card. (1^st through 8^th grade applicants only)

□ A copy of your child’s most recent standardized test results. (if applicable)

□ A $50.00 application fee (checks should be made payable to All Saints’ Episcopal School).
This is a one-time fee per student and is non-refundable unless acceptance is denied.

□ A $500.00 deposit (checks should be made payable to All Saints’ Episcopal School).
This payment serves as a deposit and is non-refundable unless acceptance is denied.

□ A completed financial aid form, if applicable, along with all required attachments. If you are interested in applying for financial aid, please request an application from Nikki Wills, Director of Admissions. The financial aid form (with required attachments listed on the form) must accompany your application for admission. Financial aid forms submitted before or after receipt of the application for admission will not be considered. Financial aid is limited. Families must produce evidence that need exists. All awards are determined by a Financial Aid Committee.

□ Other information, including but not limited to, a copy of the applicant’s birth certificate, immunization records,
transcripts, etc. if determined necessary to make an enrollment decision. Parent(s)/Guardian(s) will be notified if additional information is required.

An enrollment decision cannot be made unless all of the requested items are received.

Promptness is required in order for us to make a timely decision on your behalf.

Please send completed application, support information, application fee and the deposit to:

Mrs. Nikki Wills, Director of Admissions

All Saints’ Episcopal School

3275 Maple Valley Road

Morristown, TN 37813

Applicant Name: ______________________________

Incoming Grade: ______________________________

Enrollment Agreement

The undersigned parties understand that the obligation to pay the fees for the full academic year is unconditional and that after May 1, 2010 no portion of fees paid or outstanding will be refunded or cancelled in the event of absence, withdrawal or dismissal of the student from the school. The undersigned agree to assume full responsibility for the full annual tuition and to observe the payment schedule set out on the “Tuition Payment Schedule” below. The undersigned agree to accept the rules and regulations of the School as stated in the Parent/Student Handbook and furthermore, understand and agree to the policy of the School that no grades or transcripts shall be released unless an account has been paid in full.

If enrollment is cancelled after May 1, 2010 parents or guardians financially responsible for the student are obligated to pay the full annual tuition charges.

If ASES is notified in writing before May 1, 2010 of a student’s withdrawal, all monies paid may be refunded except for the application fee and deposit. In the event that ASES is unable to provide a class section for the student, or the student is not accepted for admission to ASES, all monies paid for the affected student may be refunded including the application fee and deposit.

Families are welcome to pay monthly tuition with VISA or MasterCard. All Saints’ Episcopal School requires that all families who choose the monthly payment plan provide the school with a valid credit card number. In the event that tuition is more than 20 days late in a month and the Business Manager has not been notified of a reason, the credit card number on file will be charged for the tuition for that month. By signing the enrollment agreement the responsible financial party agrees to this procedure for payment of monthly tuition. A credit card form is attached to this agreement and the credit card form must be completed and submitted to the Director of Admissions with the Enrollment Agreement before enrollment will be considered.

I affirm that the information I have supplied on this Application and Agreement is true to the best of my knowledge.

Parent’s Signature: ________________________________ Date: __________________

*This agreement is not valid without signatures at the designated spaces above.

Enrollment is completed when the school receives a signed Enrollment Agreement, application fee (if applicable) and the deposit payment. Once the Admissions Office has received your signed enrollment agreement, completed credit card form and your payment, we will notify you that your child has been officially enrolled. Please provide the email or mailing address to which we should send the notification.

Email Address: __________________________________________________________________
Mailing Address: ________________________________________________________________

PLEASE COMPLETE:

Tuition Payment Schedule
Financial Responsibility is Assumed by		Payment Plan Option
□ Both		□ Annual
□ Father		□ Monthly
□ Mother
□ Other Name: Address: City, State, Zip:		Monthly payments will be established if not otherwise indicated..

All fees are due the first of the month and are late after the tenth. After the tenth day of the month, a $15.00 per month late fee is imposed. Should an account become delinquent by more than 60 calendar days, a student may be asked to stop attending school until payments are made current. All tuition payments for this school year should be paid in full no later than March 10, 2011.

Unless otherwise notified, the Business Manager will e-mail monthly statements in lieu of paper statements.

The e-mail address to be used for billing purposes is: ___________________________________________________.