California Crosspoint Academy 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335

Revised 11/18/16

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California Crosspoint Academy “Transforming Lives for the Glory of God”

Dear Prospective Family:

Thank you for your interest in California Crosspoint Academy. Your child’s education and training are

very important to us and we want to assist you in making the right choice. Every school is different and not

every learning environment is best suited for every child. California Crosspoint Academy offers an excellent

and comprehensive college-preparatory academic program in a highly structured but supportive learning

community. We encourage you to visit many schools and to ask a lot of questions. Be sure you pick the

school that is the best match for your child.

California Crosspoint Academy is neither elitist nor exclusive in its admissions policy. Our ministry goal

is to develop each student’s God-given potential to the fullest. We desire to help all students who can benefit

from our educational program. Students are admitted without regard to race, color, religion, and national or

ethnic origin. As a private, religious school, we reserve the right to make admissions decisions in accordance

with our religious beliefs and mission.

The submission of an application begins the admissions process. Each application is reviewed by the

registrar for completeness and submitted to school administration for consideration. The school administrators

carefully examine each application and determine what action to take in accordance with God’s Will, the

school’s mission, and ministry impact. Some of the factors that are weighed include:

church/school connection (children of Bay Area Chinese Bible Church members, siblings of

current students, and children of staff or alumni have priority),

prior academic performance,

conduct, discipline, and maturity,

student’s parent and family support structure,

church and religious background, and

time of application.

If you have special facts or circumstances in the areas listed above that the school should consider with

your application, please include a separate, detailed explanation.

We will make every effort to act on your application as quickly as possible. If you have any questions,

please do not hesitate to contact us. Thank you again for your interest in California Crosspoint Academy.

Sincerely yours,

Mr. Robin S. Hom

Superintendent

California Crosspoint Academy 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335 Revised 11/18/16

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California Crosspoint Academy “Transforming Lives for the Glory of God”

ADMISSIONS PROCEDURES

1. Complete the Admissions Application and return it with the following:

a. Current immunization record

b. Authorization to Release Reference Information

c. Copy of your child’s last two years’ report cards

d. Copy of your child’s last two years’ standardized test results (e.g., CAT, SAT, CTBS etc)

e. Student Questionnaire

f. Teacher’s Reference/Recommendation

g. Birth Certificate

2. Once all the forms have been received, our admissions office will contact you to schedule a

placement test date. Your child will take a placement test and meet with an administrator.

3. We would like both parents to attend a personal interview with an administrator if possible.

4. An admission and placement evaluation and decision will be made by a staff team based on the

following:

a. Parents and student agreement with the school’s philosophy and policies

b. Student’s academic grade level proficiency

c. Student’s learning attitude and effort

d. Student’s conduct and classroom behavior

e. School’s ability and resources to meet the student’s needs

California Crosspoint Academy 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335

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California Crosspoint Academy “Transforming Lives for the Glory of God”

ADMISSIONS APPLICATION

Student Information

LEGAL LAST NAME LEGAL FIRST NAME

PREFERRED NAME PRIMARY LANGUAGE

SCHOOL YEAR APPLYING FOR

20_____

GRADE APPLYING FOR CURRENT GRADE

□ MALE □ FEMALE PASSPORT NUMBER

ID#/SOCIAL SECURITY NUMBER

STREET ADDRESS

CITY PROVINCE/STATE COUNTRY ZIP CODE

HOME PHONE

EMAIL

DATE OF BIRTH PLACE OF BIRTH (City, State, Country)

STUDENT’S CELL PHONE STUDENT’S DRIVER’S LICENSE

Parent Information

FATHER MOTHER

LAST NAME, FIRST

STREET ADDRESS

CITY

PROVINCE /STATE

ZIP CODE

COUNTRY

EMAIL

HOME PHONE

( ) - ( ) -

CELL PHONE

( ) - ( ) -

EMPLOYER

OCCUPATION

WORK PHONE

( ) - ( ) -

PRIMARY LANGUAGE

California Crosspoint Academy 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335

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Family Information

PARENTS’ MARITAL STATUS:

□ MARRIED

□ WIDOWED

□ DIVORCED

□ SEPARATED

SEND SCHOOL NOTICES TO: (Check all that apply)

□ JOINT

□ FATHER

□ MOTHER

□ GUARDIAN

LEGAL CUSTODY OF THE CHILD IS WITH:

□ JOINT

□ FATHER

□ MOTHER

□ GUARDIAN

SPECIAL CUSTODY OR VISITATION ARRANGEMENTS

BROTHERS or SISTERS LIVING AT HOME

NAME BIRTHDATE SCHOOL ATTENDING GRADE

Academic Information

LAST SCHOOL ATTENDED

GRADE LEVEL AVG. HRS. OF HOMEWORK PER NIGHT:

SCHOOL ADDRESS SCHOOL PHONE

CITY SCHOOL FAX NUMBER

PROVINCE /STATE ZIP CODE SCHOOL WEBSITE

REASON FOR LEAVING PREVIOUS SCHOOL:

HAS THE STUDENT EVER BEEN EXPELLED, SUSPENDED, PLACED ON PROBATION, OR INVOLVED IN AN INCIDENT INVOLVING

VIOLENCE, DRUG ABUSE, GANGS, VANDALISM, OR LAW ENFORCEMENT? IF YES, EXPLAIN FULLY.

LIST ALL REQUIRED PHYSICAL OR ACADEMIC ACCOMODATIONS MADE IN SCHOOL LAST ATTENDED:

PLEASE INCLUDE ANY ADDITIONAL INFORMATION YOU WOULD LIKE THE SCHOOL TO KNOW.

California Crosspoint Academy 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335

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STUDENT QUESTIONNAIRE

1) What are your favorite subjects and why?

2) Write about something you learned that was very important, valuable, and exciting to you. Is there something else that you have always wanted to do or learn?

3) What qualities do you like and value most about yourself? What personal qualities would you like to improve?

4) Describe a person you admire and look up to. Why do you respect this person? How is this person important to you?

5) What are your plans for college?

6) What occupation or profession do you want to enter? Why?

7) Why do you think you will do well in a structured environment where a student’s conduct, speech, character, and attitude are emphasized as much as academics?

8) List any church or religious activities you attend regularly:

9) Briefly describe your spiritual life. Are you a born-again Christian? Have you been baptized? Do you pray or read the Bible?

10) Do you want to attend California Crosspoint Academy? Why or why not?

California Crosspoint Academy 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335

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California Crosspoint Academy, 25500 Industrial Blvd., Hayward, CA 94545 Tel: (510) 995-5333 Fax: (510) 995-5335

Revised 11/3/2016

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California Crosspoint Academy “Transforming Lives for the Glory of God”

AUTHORIZATION TO RELEASE REFERENCE INFORMATION

(including academic, medical, psychological, and disciplinary records)

________________________ has made application to enroll in California Crosspoint Academy. As

parent or guardian, I have authorized California Crosspoint Academy to thoroughly investigate

references, academic records, evaluations, discipline, and other matters related to my child’s suitability

for enrollment.

I authorize references and staff from my child’s former school(s) to disclose to California Crosspoint

Academy any and all school applications, academic records, progress reports, disciplinary, medical or

psychological reports, and other information related to my child’s academic and school life, without

giving me prior notice of such disclosure.

In addition, I hereby release California Crosspoint Academy, my child’s former school(s), and their

staff, references, and all other parties from any and all claims, demands, or liabilities arising out of or

in any way related to such investigation or disclosure.

I waive the right to ever personally view any references given to California Crosspoint Academy.

I agree that a photocopy or facsimile copy of this document and any signature shall be considered for

all purposes as the original signed release on file.

I certify that I have carefully read and do understand the above statements.

Applicant’s Name (Print) _____________________________ Current Grade __________________

Parent or Guardian’s Signature __________________________________ Date __________________

Applicant’s Birth Date ______________________________ Social Security # __________________

California Crosspoint Academy Address: 25500 Industrial Blvd., Hayward, CA 94545 Phone: 510.995.5333 Fax: 510.995.5335

To the Parent: We are requesting that your child’s Academic counselor or homeroom teacher complete this form. Please send it with your child’s application. California Crosspoint Academy reserves the right to verify the references given.

Student Assessment

Student’s Name: Grade Level: School phone #: Core Teacher: Teacher ‘s signature: School Seal: Student’s Personal Qualities: (check the most appropriate box for each characteristic)

No

chance to

observe

Characteristic Below

Average

Average

(top 25-

50%)

Good

(top 11-

24%)

Excellent

(top 10%)

Superior

(top 5%)

Academic Ability

Inquisitiveness

Creativity

Self-Confidence

Leadership Potential

Teachability

Concern for Others

Behavior/Conduct

Honesty

Independence

Personal Maturity

1. Does this student’s grades and test scores accurately reflect his/her strengths and abilities?

Yes No (If no, please explain) 2. Has the student ever had a serious discipline issue? No Yes (If yes, please explain) 3. What three words first come to mind when thinking of this student? Please write a recommendation letter on the back of this sheet or on a separate sheet of letterhead as to why you think this student will be successful studying in CCA.