Apply online – Haprep

Section

l. Applicant Information

First Name *

Middle Name (optional)

Last Name *

Date of Birth *

Country of Citizenship *

Country of Birth *

Gender

Male

Female

Primary Phone Number *

Primary Email *

Proposed Enrollment Date *

Proposed Enrollment Grade *

Current Grade *

Home Address

Address Line 1 *

Address Line 2

City *

State/Province *

ZIP / Postal *

Country *

Section

II. Parent/Guardian Information

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Relationship to Applicant *

Parent/Guardian 1 Primary Phone Number *

Parent/Guardian 1 Primary Email *

Address Same As Applicant *

Yes

No

Parent/Guardian 1 Address*

Parent/Guardian 1 Address Line 1 *

Parent/Guardian 1 Address Line 2

Parent/Guardian 1 City *

Parent/Guardian 1 State/Province *

Parent/Guardian 1 ZIP / Postal *

Parent/Guardian 1 Country *

Parent/Guardian 1 Business Address

Parent/Guardian 1 Occupation *

Parent/Guardian 1 Name of Company

Parent/Guardian 1 Address Line 1

Parent/Guardian 1 Address Line 2

Parent/Guardian 1 City

Parent/Guardian 1 State/Province

Parent/Guardian 1 ZIP / Postal

Parent/Guardian 1 Country

Parent/Guardian 2

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Relationship to Applicant

Parent/Guardian 2 Primary Email

Parent/Guardian 2 Primary Phone Number

Parent/Guardian 2 Address

Parent/Guardian 2 Address Same As Applicant

Yes

No

Parent/Guardian 2 Address Line 1

Parent/Guardian 2 Address Line 2

Parent/Guardian 2 City

Parent/Guardian 2 State/Province

Parent/Guardian 2 ZIP / Postal

Parent/Guardian 2 Country

Parent/Guardian 2 Business Address

Parent/Guardian 2 Occupation

Parent/Guardian 2 Name of Company

Parent/Guardian 2 Address Line 1

Parent/Guardian 2 Address Line 2

Parent/Guardian 2 City

Parent/Guardian 2 State/Province

Parent/Guardian 2 ZIP / Postal

Parent/Guardian 2 Country

Student resides with: *

Both Parents

Mother

Father

Other

Student resides with other

Mail official correspondence to: *

Both Parents

Mother

Father

Other

Mail official correspondence to other

Check if appropriate *

Check if appropriate other

Legal custody of applicant: *

Both Parents

Mother

Father

Other

Legal custody of applicant other

Section

III. Applicant's Educational History

Present School *

Type of School *

Private School

Public School

Other

Type of school other

Present School Address

Address Line 1 *

Address Line 2

City *

State/Province *

ZIP / Postal *

Country *

Head of School (Name & Title) *

School Phone Number & Email *

Dates of Attendance

Other Schools Attended & Dates of Attendance (Past Three Years) *

Please upload current transcript (if available)

Maximum file size: 134.22MB

Please upload birth certificate (if available)

Maximum file size: 134.22MB

Please upload shot record (if available)

Maximum file size: 134.22MB

Please upload insurance card (if available)

Maximum file size: 134.22MB

If transcript is unavailable, please list all current subjects and current grades.

Please check all applicable fields *

Student is enrolled in honors or advanced classes

Student has an IEP or specialized learning plan

Student has an educational psychological evaluation

None of the above

Please list clubs, organizations, and athletic teams in which the applicant has participated during the past three years

Please provide email contact for at least two sources of recommendation.

At least one of the sources should be familiar with your student in the school setting, such as a teacher, counselor or administrator who has worked with your student. The other source can be any adult (outside of immediate family members) who can speak to the character of the applicant. By providing these contacts, you are giving permission for them to comment on your student's performance and their impressions of your student's strengths and weaknesses. Additional letters of reference are also welcomed.

Section

IV. Recommendations

Name of Academic Reference

First Name *

Last Name *

Title of Academic Reference *

Email of Academic Reference *

Phone Number of Academic Reference *

Name of Personal Reference

First Name *

Last Name *

Title of Personal Reference *

Email of Personal Reference *

Phone Number of Personal Reference *

Additional Reference (Optional)

First Name

Last Name

Title & Relationship to Applicant

Email & Phone Number of Additional Reference

Applicant's Conduct History

V. Applicant's Conduct History (Confidential)

Please answer thoroughly to provide us a full understanding of the applicant.

Please check any that apply to the applicant's history: *

Suspension: in-school or out-of-school

Expulsion or asked to withdraw from school

None of the above

Other

Applicant's history other

History of alcohol or substance use? *

Yes

No

List all alcohol or illegal substances

Involvement with legal authorities? *

Yes

No

List all legal authorities

Please provide additional details for any of the above items that apply.

Applicant's Medical History

VI. Applicant's Medical History

The school requires that a completed immunization record and a medical information form signed by a physician be submitted by the first day of class. Documents will be provided upon notification of acceptance.

Name of applicant's primary healthcare provider *

Healthcare provider's phone number *

Has the applicant ever been diagnosed with a communicable disease? *

Yes

No

List any communicable diseases

Has the applicant been vaccinated for COVID-19? *

Yes

No

Please provide an image of your vaccination card

Maximum file size: 134.22MB

Does the applicant have any medical conditions that would prevent him/her from participating in the school's physical education or athletic programs? *

Yes

No

List all medical conditions

Is the applicant currently taking any medications? *

Yes

No

List any medications the applicant is currently taking, including dosage, date started, doctor's name, and phone number

Does the applicant have any known food allergies? *

Yes

No

Please provide known allergies.

Does the applicant have an up to date physical (within the last year)? *

Yes

No

Please upload physical information document

Maximum file size: 134.22MB

Has the applicant ever received professional counseling? *

Yes

No

Please provide name and contact number of a current counselor (if applicable).

Additional Information

The applicant and his/her parents give permission for the applicant's photograph and name to appear in the school publications and promotional materials? *

Yes

No

Please indicate how you heard of HA Prep Academy? *

How did you hear of HA Prep Academy?

Alumni Relationships

Religious Affiliation

Ethnicity

This information will in no way affect admission decisions.

HA Prep Academy does not discriminate on the basis of religion, race, sex, or geographic origin.

Please read carefully before signing and submitting:

I certify that I have read and understood this application, and I further certify that the information I have submitted is complete and correct to the best of my knowledge and belief. I agree to communicate to the Administrative Offices in writing if any changes in any matters contained herein even if such changes occur after the student has been enrolled. I understand that upon discovery of any inaccuracy of information contained herein, or omission of information requested herein, HA Prep Academy reserves the right to revoke any admission granted.

Name of Parent/Guardian

First Name *

Last Name *

Please note; that the student's application will not be reviewed until receipt of the non-refundable application fee of $50 has been received.

Signature of Parent/Guardian *

Clear

Person(s) who will assume responsibility for payment of tuition, room, board and fees: *

Relationship to Applicant *

Responsible party's bank name: *

Click the SUBMIT FORM button below to complete your online application. Questions? Contact us!

Email: admin@haprep.org

Phone: (919) 748-0212

reCAPTCHA