International student application

Section

l. Applicant Information

First Name *

Middle Name (optional)

Last Name *

Preferred Name

Date of Birth *

Country of Citizenship *

Country of Birth *

Gender

Male

Female

Passport Number *

Does the applicant currently have: *

F-1 Student Visa

Permanent Resident (Green Card)

Other

Proposed Enrollment Date *

Current Grade *

Proposed Enrollment Grade *

Primary Phone Number *

Primary Email *

Applicant's Address

Address Line 1 *

Address Line 2

City *

State/Province *

ZIP / Postal *

Country *

Section

II. Parent/Guardian Information

First Name *

Last Name *

Relationship to Applicant *

Parent/Guardian 1 Primary Phone Number *

Parent/Guardian 1 Primary Email *

Address Same As Applicant *

Yes

No

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 Company Information

Parent/Guardian 1 Occupation *

Parent/Guardian 1 Name of Company

Parent/Guardian 1 Company Address Line 1

Parent/Guardian 1 Company Address Line 2

Parent/Guardian 1 Company City

Parent/Guardian 1 Company State/Province

Parent/Guardian 1 Company ZIP / Postal

Parent/Guardian 1 Company Country

Parent/Guardian 2

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Relationship to Applicant

Address Same As Applicant Parent/Guardian 2

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 Company Information

Parent/Guardian 2 Occupation

Parent/Guardian 2 Name of Company

Parent/Guardian 2 Company Address Line 1

Parent/Guardian 2 Company Address Line 2

Parent/Guardian 2 Company City

Parent/Guardian 2 Company State/Province

Parent/Guardian 2 Company ZIP / Postal

Parent/Guardian 2 Company Country

Student Resides with: *

Both Parents

Mother

Father

Other

Student Resides with oOther

Mail official correspondence to: *

Both Parents

Mother

Father

Other

Mail official correspondence to other

Legal custody of applicant: *

Both Parents

Mother

Father

Other

Legal custody of applicant other

Does the applicant have a legal guardian in the United States? *

Yes

No

Are there any other authorized contacts?

III. Applicant's Educational History

Present School *

Type of School *

Private School

Public School

Other

Type of school other

Present School Address Line 1 *

Present School Address Line 2

Present School City *

Present School State/Province *

Present School ZIP / Postal *

Present School Country *

Head of School (Name & Title) *

School Phone Number & Email *

Dates of Attendance *

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

Please list all current subjects and current grades *

Please check all applicable fields *

Student is enrolled in advanced classes

Student is enrolled in the IB program

Other

Please check all applicable fields other

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

IV. Recommendations

Recommendations

School Administrator Reference Name *

School Administrator Title & Email *

Math Teacher Reference Name *

Math Teacher Email *

English Teacher Reference Name *

English Teacher Email *

V. Applicant's Conduct History

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

Do you have a history of alcohol or tobacco use? *

Yes

No

Please provide additional details

VI. Applicant's Medical History

Applicant's Medical History

Name of applicant's primary healthcare provider *

Healthcare provider's phone number (please include country code) *

Has the applicant ever been diagnosed with a communicable disease? If yes, please provide details. *

Yes

No

List any communicable diseases

Is the applicant currently taking any medications? *

Yes

No

Please list any medications

Does the applicant have any medical conditions that would prevent him/her from participating in the school's physical education or athletic program? If yes, please provide details. *

Yes

No

List all medical conditions

Has the applicant ever been hospitalized? *

Yes

No

Please provide brief details on any hospitalizations in the applicant's history

Has the applicant ever received professional counseling? If yes, please provide details. *

Yes

No

Please provide name and contact number (include country code) of a current counselor

VII. 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 to be used in school publication (print and electronic)

Yes

No

Please indicate how you heard of HA Prep Academy? *

How did hear about HA Prep academy

Alumni Relationship

Religious Affiliation

Ethnicity

Please read carefully before signing and submitting:

Parent/Guardian First Name *

Parent/Guardian Last Name *

Signature of Parent/Guardian *

Clear

Use your mouse or finger to draw your signature

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

Name/Relationship to Applicant *

Responsible party's bank name and address: *

Please upload two recommendation letters (if available)

Maximum file size: 516MB

Please upload photo of yourself *

Maximum file size: 516MB

Please upload official school transcripts (if available)

Maximum file size: 516MB

Please upload TOEFL score (if available)

Maximum file size: 516MB

Please upload two recommendation letters (if available)

Maximum file size: 516MB

Please upload copy of passport page that shows your name and date of birth *

Maximum file size: 516MB

Please upload a parent bank statement that shows the ability to pay school fees (if available)

Maximum file size: 516MB

Click the SUBMIT FORM button below to complete your online application.

Questions? Contact us!

Email: admin@haprep.org Phone: (919) 748-0212

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