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Requesting Information

Thank you for your interest in Jim Elliot Christian High School!

Please fill out the form below with your information, and our office will be in contact with soon. 

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Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • How Did You Hear About Us? *
    Details:
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  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School
    Other:
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  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
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