Sie sind auf Seite 1von 2


The following questions are to be answered by the applying 7th through 12th grade student in his/her own
handwriting. If more space is needed, use a separate sheet putting the student’s full name in the upper right corner
and then in the left column, numbering the questions being answered. This completed questionnaire must be
returned with the rest of the packet.

Name Sex Grade Entering

Male Female

0 I. Questionnaire

1. How did you find out about Middletown Christian Schools?

2. Do you yourself want to come to school here? Yes No Explain.

3. If you are a Christian, how do you know?

How long have you been a Christian?

Do you attend church regularly? Yes No Where?

Do you go to Sunday School regularly? Yes No Where?

Does your church have a youth group? Yes No Are you active in the youth group? Yes No
In what way are you active?

Describe any other ministry of your church you participate in.

Do you have a regular time for Bible reading and prayer? Yes No Why or why not?

Describe some areas of your life in which you feel God is now working?

4. What talents do you have (music, art, etc.). Be specific.

5. What are your hobbies and interests? Be specific.

6. What sports do you play?

7. Name the last two books you have read.

8. What type of music do you listen to? (classical, contemporary, country, rock, heavy-metal, etc.)

What radio stations do you listen to?

What musical artists do you like?

9. What are your favorite television programs?

10. Name the last three movies you have seen.


11. Do you have a job after school or on weekends? Yes No If so, what is it?

12. Are most of your friends and associates Christians? Yes No

Are most of your friends the same age as you are? Yes No
13. What are your favorite subjects in school?

What are your least favorite subjects in school?

14. Have you ever been suspended or expelled from school? Yes No If yes, explain in detail.

15. Have you ever been in trouble with the police or the law? Yes No If yes, explain in detail.

16. Have you ever used tobacco? Yes No Drugs? Yes No Alcoholic drinks? Yes No
If any yes answer, please explain fully.

17. On a separate sheet of paper, write your testimony of salvation which deal with the following questions:
a) According to the Bible, what is a Christian?
b) According to the Bible, how does one become a Christian?
c) When and how did you become a Christian?
18. Did you have any help answering the above questions? Yes No If so, explain which questions
and how much help you received.

2 II. Statement of Cooperation

In signing this Student Questionnaire, I acknowledge the following:

A. My commitment to further my Christian education by faithful attendance at a Bible-believing church.

B. My commitment to the Statement of Faith of Middletown Christian Schools.
C. My agreement to obey the authorities at Middletown Christian Schools both in attitude and action.
D. My agreement that I will obey the rules as set forth in the Student Handbook and to abide by the dress code.
E. My commitment to follow Matthew 18:15-17 and Galatians 6:1-2 if:
1) I have a disagreement with a teacher or other authority;
2) I learn of some sin or infraction of the rules by a student at Middletown Christian Schools.
I agree to, in a meek attitude, go to the person and try to settle the problem. If it is not settled, to bring
someone who is spiritually mature and try again. If it is still not settled, to go to an authority and report the
F. My commitment to conduct myself in such a way as not to bring reproach on the Name of Christ or the
reputation of the school.
G. My commitment to do my best at whatever I am required or asked to do (Ecclesiastes 9:10).
H. I certify that I have answered the above questions honestly and completely and have not withheld any
information which may affect my admission to Middletown Christian Schools.

Student Signature Date