2021-22 Enrollment Application
Please complete the following questions if you would like to learn more about Hope Academy
Grade Entering in 2021 *
Students Name *
Current School *
Birthday *
MM
/
DD
/
YYYY
Gender *
Ethnicity:
With whom does the student applicant live?
Student Home Address *
City *
State *
Zip *
Mother’s Name
Home Address (If different from student)
City
State
Zip
Mother’s Home Phone
Mother’s Cell Phone
Mother’s E-mail Address
Mother’s Employer
Father’s Name
Home Address (If different from student)
City
State
Zip
Father's Home Phone
Father’s Cell Phone
Father’s E-mail Address
Father’s Employer
Additional Family Member/ Guardian:
Relationship To The Student
Additional Family Member Home Address:
City
State
Zip:
Additional Family Member Cell Phone:
Additional Family Member Email Address:
What was your total household income last year? *
How many dependents live in the applicants home? *
If there are siblings in the home, what grade are they in? If none, write "none" *
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