Domestic student application

Domestic student application


l. Applicant Information

Home Address


II. Parent/Guardian Information

Address Same As Applicant *

Parent/Guardian 1 Address*

Parent/Guardian 1 Business Address

Parent/Guardian 2

Parent/Guardian 2 Address

Parent/Guardian 2 Address Same As Applicant

Parent/Guardian 2 Business Address


III. Applicant's Educational History

Present School Address

Maximum file size: 134.22MB

Maximum file size: 134.22MB

Maximum file size: 134.22MB

Maximum file size: 134.22MB

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.


IV. Recommendations

Name of Academic Reference

Name of Personal Reference

Additional Reference (Optional)

Applicant's Conduct History

V. Applicant's Conduct History (Confidential)

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

History of alcohol or substance use? *
Involvement with legal authorities? *

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.

Has the applicant ever been diagnosed with a communicable disease? *
Has the applicant been vaccinated for COVID-19? *

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? *
Is the applicant currently taking any medications? *
Does the applicant have any known food allergies? *
Does the applicant have an up to date physical (within the last year)? *

Maximum file size: 134.22MB

Has the applicant ever received professional counseling? *

Additional Information

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

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

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


Phone: (919) 748-0212