Parent Questionnaire for High School Students 
Complete this form if you are applying for your high schooler.
Email *
PERSONAL INFORMATION
Parent's Full Name - Completing Form *
Complete Mailing Address:  Street, City, Zip Code *
Cell Phone Number *
Preferred Method of Contact *
Parent #2:  Full Name
Parent #2 Address if different from above
Cell Phone Number
Who does the student primarily live with?  (If there is a step-parent, please provide the name below). *
How did you hear about us? *
Student's First and Last Name *
Student's Age *
Student's Date of Birth *
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Why would you like your child to be part of Hope Learning Center? *
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