Basic Skills Assessment & Educational Services 503-650-5282 Located in Oregon City Oregon

DIPLOMA PROGRAM APPLICATION
____________________STUDENT INFORMATION__________________ *required fields
*First Name
*Last Name				Grade Entering
*Street				*Birthdate (mm/dd/yyyy)
*City				Birthplace
*State			*ZIP	Last School Attended
*Home Phone				Grades Attended	-
Other Phone				Reasons for leaving
_______________________FAMILY INFORMATION_________________
		*Parent's Email		Student's parents are:	Student Lives With
Father's Name				Father's Occupation
Father's Work Phone				Father's Employer

Mother's Name				Mother's Occupation
Mother's Work Phone				Mother's Employer

_______________ACADEMIC EVALUATION_____________
		Overall academic ability		English Skills	Social Studies Aptitude
		Science Aptitude		Math Ability	Involvement Outside of School
		Respects Authority		Emotional Stability	Social Adjustment to Peers
		Demonstrates Leadership		Responsibility	Honesty
		Hardworking		Motivation	Personal Appearance
		Additional Comments Additional comments about your student that might be helpful.
_________________OTHER INFORMATION________________
		How you heard about the Diploma Program		Church Name
		Referred by		Denomination
	Basic Skills Commitments: We will provide the above named family with: Assistance with course and curriculum selection Two 45 to 60 minute advising and evaluation sessions at the end of each semester Two 30 to 45 minute advising sessions at the parent’s request at the end of first and third quarters A report card for students in grades 7-8 A transcript for students in grades 9-12 Complimentary achievement testing Telephone/e-mail support to answer brief questions throughout the year. Unlimited letters of recommendation to colleges Unlimited transcript creation as requested by prospective colleges and universities. Transfer of all previous earned credits Maintenance of your academic record for future access indefinitely Credit recovery and transcripting of previous at a special hourly rate Additional appointments, if requested by the parent, at a special hourly rate. A diploma awarded at a commencement ceremony when graduation requirements are met.
	Family Commitments: Checking the two boxes below confirms... That you have read and agree to follow the procedures in the NCCA Diploma Program Handbook. That all tests and quizzes will be closed-book and without help relative to the concepts being evaluated – unless otherwise approved by your Diploma Program Advisor. That all work recorded on the Record of Grades form is scored and recorded only by a parent; that all work recorded on the Course Journal is confirmed and totaled by a parent. That Basic Skills Assessment & Educational Services/NCCA are advisory and supportive only and that the above-named family bears sole responsibility for the use and implementation of these services. We agree to follow the above Family Commitments. Parent Agrees to Standards Student Agrees to Standards

Basic Skills Assessment & Educational Services		Voice: 503.650.5282	Fax: 503.650.8578
Basic Skills \| Educational Products \| Affiliates \| FAQ \| Community Forum \| Contact Us

DIPLOMA PROGRAM APPLICATION

____________________STUDENT INFORMATION__________________ *required fields

_______________________FAMILY INFORMATION_________________

_______________ACADEMIC EVALUATION_____________

_________________OTHER INFORMATION________________

__STUDENT INFORMATION
*required fields

_______FAMILY INFORMATION_

___ACADEMIC EVALUATION_

_OTHER INFORMATION