Request edit access
HCA Information Form for 2017-18 Enrollment
Student first name *
Your answer
Student last name *
Your answer
Student's grade for the 2017-18 school year *
Student's primary mailing address line 1 *
Your answer
Address line 2
Your answer
City *
Your answer
State
Zip code *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
School district of primary residence *
Current school name
Homeschooled students please enter 'Homeschooled'.
Your answer
Does student have a sibling who currently attends HCA? *
Is student the child of an HCA founder or full-time faculty member?
Parent/ Guardian #1 Information
Parent/Guardian #1 first name *
Your answer
Parent/Guardian #1 last name *
Your answer
Parent/Guardian #1 relationship to student
Parent/Guardian #1 email address *
Your answer
Parent/Guardian #1 primary phone number *
Your answer
Parent/Guardian #1 address
(if different than student)
Your answer
What is the best way to reach parent #1?
Parent/Guardian #2 Information
Parent/Guardian #2 first name
Your answer
Parent/Guardian #2 last name
Your answer
Parent/Guardian #2 relationship to student
Parent/Guardian #2 email address
Your answer
Parent/Guardian #2 primary phone number
Your answer
Parent/Guardian #2 address
(if different than student)
Your answer
Parent/Guardian #2 city
(if different than student)
Your answer
Parent/Guardian #2 state
(if different than student)
Your answer
Parent/Guardian #2 zip code
(if different than student)
Your answer
What is the best way to reach parent #2?
Additional Information
How did you hear about HCA?
Confirmation
The second and final step to sign up for enrollment at HCA is to complete, sign, and send in the "Declaration of Intent to Enroll" form available on our website.
Please let us know if you have sent in your 'Declaration of Intent to Enroll' form here.
Next Steps
HCA intends to enroll 50 students for 6th grade, 20 students for 9th grade, and will fill openings in the existing classes for 7th, 8th, 10th & 11th grades as they are available. If we have more applicants than spaces available, a lottery will be held on March 31th 2017 to fill our classes. Advance notice of the lottery will be sent to all applicants, and selected students will be informed after the lottery is held. Applicants who submit this form and the Declaration of Intent to Enroll form after the Thursday, March 23rd, 2017 deadline will be placed on a waiting list, which will be a first come, first served wait list.

Thank you!

Submit
Never submit passwords through Google Forms.
This form was created inside of Harpswell Coastal Academy. Report Abuse - Terms of Service - Additional Terms