Application for
Richmond Academy of Seventh-day Adventists

3809 Patterson Ave.
Richmond, Virginia 23221
(804) 353-0036

Please complete this form on-line, print and sign it, and mail it to Richmond Academy.
Application for school year Entering Grade:

Applicant Information

Name
Last: First: Middle:

Nickname: Home Phone #:

Date of Birth: Age: Social Security Number:

Home Address
Street:
City: State: Zip Code:


Is student baptized SDA member? Date of Baptism:

Present School: Present Grade:
Address
Street:
City: State: Zip Code:

Authorization to release transcripts:

List any physical disabilities:



List any special interests of applicant:


Names of other schools to which you have applied:
Has any testing been administered by these schools or an independent testing organization? If so, by whom?

Number of brothers: Ages: School:
Number of sisters: Ages: School:

Parent Information

FATHER'S/GUARDIAN'S NAME:
Living? Employer:
Job Title
Address is different from above:
Business Phone: May we call you at work?
Church Affiliation?



MOTHER'S/GUARDIAN'S NAME:
Living? Employer:
Job Title
Address is different from above:
Business Phone: May we call you at work?
Church Affiliation?



With whom does applicant live?
Address:
Person Responsible for Payment:
Address (if different from above):

References

(for students applying to Grades 7-12)

Teacher:
Address:

Pastor:
Address:

Adult other than relative:
Address:


I HAVE READ THE TERMS OF ADMISSION AND THE POLICIES OF RICHMOND ACADEMY.


______________________
Date

________________________________________
Signature of Parent of Guardian

________________________________________
Signature of Student