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Request Information

Thank you for your interest in Christian Central Academy!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Cell Phone *
Home Address
  • Street Address *
  • City *
  • Country *
  • State
    *
  • Zip
    *
  • How Did You Hear About Us? *
    Details:

  • Do you know any current CCA families?
    * Yes   No

  • Would you like to schedule a personal tour?
    * Yes   No

  • Would you like to schedule a Shadow day for your son or daughter? (Grades 5-11)
    * Yes   No

  • Please share reasons why you are interested in your son or daughter attending Christian Central Academy:
    *

  • Please list any questions you are looking for answers for regarding, sports, music, or clubs:
    *

  • Please list any questions you have in regards to high school electives (AP classes, STEM, Computer Programming, Art, Dual Enrollment, etc.)
    *
  •  
  • Student 1
  • First Name *
    Middle Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •