Welcome!
Bachman
Academy welcomes applications from students, age
11 to 18, regardless of race, color, gender,
religion, national and ethnic origin. The
application for admission is complete when
Bachman Academy has received the following:
Online
Application for Enrollment
All
fields are required.
|
|
|
|
|
|
Referral
|
|
Month/year of proposed
entrance
|
/
|
|
Current
grade
|
|
Applying for grade
|
|
|
|
Applicant
Information
|
|
|
|
Full Name
|
|
Preferred
name or nickname
|
|
|
Permanent Address
|
|
City
|
|
|
State
|
Zip
|
Country
|
|
|
Date of Birth
|
|
City,
country of Birth
|
|
|
Citizenship
|
|
Social
Security #
|
|
|
E-mail
|
|
Home
Phone
|
|
|
|
|
Fax
|
|
|
|
Family Data - Parent/Guardian
|
|
Full Name
|
|
Occupation
|
|
|
Company
|
|
|
|
|
Home Address
|
|
City
|
|
|
State
|
Zip
|
Country
|
|
|
Business Address
|
|
City
|
|
|
State
|
Zip
|
Country
|
|
|
Business Phone
|
|
Home
Phone
(include country codes)
|
|
|
E-mail
|
|
Fax
|
|
|
|
Family Data - Spouse
Information
|
|
Full Name
|
|
Occupation
|
|
|
Company
|
|
|
|
|
Home Address
|
|
City
|
|
|
State
|
Zip
|
Country
|
|
|
Business Address
|
|
City
|
|
|
State
|
Zip
|
Country
|
|
|
Business Phone
|
|
Home Phone
(include country codes)
|
|
|
E-mail
|
|
Fax
|
|
|
|
Family Data - Sibling #1 Information
|
|
Full Name
|
|
Age
|
|
|
Occupation
|
|
School
Attending
|
|
|
Family Data - Sibling #2 Information
|
|
Full Name
|
|
Age
|
|
|
Occupation
|
|
School
Attending
|
|
|
Family Data -
Sibling
#3 Information
|
|
Full Name
|
|
Age
|
|
|
Occupation
|
|
School Attending
|
|
|
To
whom should primary contact be made
|
|
Full Name
|
|
|
|
Legal
Guardian - If other than parents
|
|
|
Full Name
|
|
|
|
|
Academic Data
All
applications must have official transcripts from each jr. high school
attended. Mail in to Office of
Admissions, Bachman Academy, 414 Brymer Creek Rd., McDonald, TN
37353.
|
|
School
Attended #1
|
|
|
|
Name of School
|
|
Telephone
|
|
Location
City/ State
|
|
Dates Attended
From/To
|
|
|
Grade Completed
|
|
|
|
|
School
Attended #2
|
|
Name of School
|
|
Telephone
|
|
Location
City/State
|
|
Dates Attended
From/To
|
|
|
Grade Completed
|
|
|
|
|
School Attended #3
|
|
Name of School
|
|
Telephone
|
|
Location
City/State
|
|
Dates Attended
From/To
|
|
|
Grade Completed
|
|
|
|
|
|
Extracurricular
Activities / Areas of Interest
|
|
|
|
Employment
History
Please
list any jobs, whether paid or volunteer, which the student has held.
|
|
Job
#1
|
|
Name
of Company
|
|
Telephone
|
|
|
Dates of Employment
|
|
Positions Held
|
|
|
Job
#2
|
|
Name
of Company
|
|
Telephone
|
|
|
Dates of Employment
|
|
Positions Held
|
|
|
Job #3
|
|
Name
of Company
|
|
Telephone
|
|
|
Dates of Employment
|
|
Positions Held
|
|
|
Additional
Information
Please
include any information that may be helpful in reviewing the student's
school and/or
psychological
records.
|
|
|
Goals
Please
briefly list or describe your goals while a student/resident at
Bachman Academy.
|
|
Student
Academic Goals
|
|
|
Student
Personal Social
Goals
|
|
|
Parent's
Academic Goals for Student
|
|
|
Parent's
Personal
Social Goals for Student
|
|
Helpful Information
Please
include additional information regarding the student which will be
helpful to our staff in working with him/her.
|
|
|
|
Medical History
Please
submit a copy of student's immunization record. List medical
diagnoses for which the student
has received on-going treat by a licensed health care provider.
|
|
Medical
Diagnoses #1
|
|
|
|
Diagnoses
|
|
Date of Diagnoses
|
|
|
Name of Physician
|
|
Address of Physician
|
|
|
Medical Diagnoses #2
|
|
Diagnoses
|
|
Date of Diagnoses
|
|
|
Name of Physician
|
|
Address of Physician
|
|
|
Medical
Diagnoses #3
|
|
Diagnoses
|
|
Date of Diagnoses
|
|
|
Name of Physician
|
|
Address of Physician
|
|
Social / Emotional Medical History
Please
list any psychiatric or psychological diagnoses for which the
student received intervention,
ie., medication, counseling, or hospitalization.
|
|
Social
/ Emotional Diagnoses #1
|
|
Diagnoses
|
|
Date of Treatment
|
|
|
Name of Physician
|
|
Address of Physician
|
|
|
Social
/ Emotional Diagnoses #2
|
|
Diagnoses
|
|
Date of Treatment
|
|
|
Name of Physician
|
|
Address of Physician
|
|
Social
/ Emotional Additional
Information
Please
provide any additional information regarding emotional issues which may
affect the
student's performance or participation.
|
|
|
|
Signatures
Thank
you for completing this application. Please review the application for
accuracy and submit.
|
|
Parent / Guardian Signature
|
|
Relationship to Student
|
|
|
Student Signature
|
|
Date
|
|
|
|
|
|
|
|
|
|
|
|