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Summer Session 2008 Application

Full Name of applicant exactly as it appears on birth certificate or passport
 
  *Last/Family Name *First/Given Name Middle Name
Nickname (for teachers to use):
*Current grade (or grade/level last completed):
Student's e-mail:
Student's cell phone:
*Date of birth: Month   Day   Year
*Age:
*Gender: Male     Female
*Place of Birth:
      City       State/Province       Country
*Citizenship (list all):
How did you learn about HPA?
Live-in area/reputation Consultant Advertisement - which one?
Alumni Coach School Fair - which one?
Past HPA summer student HPA Web site Other Web site - which one?
Other  
*Applying for:
DAY STUDENT 7-DAY BOARDING STUDENT
Grade 6 Grade 9 Grade 6 Grade 9
Grade 7 Grade 10 Grade 7 Grade 10
Grade 8 Grade 11 Grade 8 Grade 11
  Grade 12   Grade 12
HOUSEHOLD 1 (APPLICANT'S PRIMARY HOME ADDRESS)
Primary home residence for the applicant or where mail is received.
NOTE: Admission material is sent to HOUSEHOLD 1 unless otherwise indicated in Custodial Information section.
*Address (line 1):
Address (line 2):
*City:
*State/Province:
ZIP/Postal Code:
*Home phone:
( ) ( )
Country code City Code Phone Number
Home fax:
( ) ( )
Country code City Code Phone Number
Cell Phone:
( ) ( )
Country code City Code Phone Number
Other contact information:
PARENTS/GUARDIANS OF HOUSEHOLD 1
Please provide the following information about the parents/guardians who reside at this address with the applicant.
ADULT 1
*Relationship to Applicant:
Occupation:
Business Name:
Business Address (line 1):
Business Address (line 2):
City:
State/Province:
ZIP/Postal Code:
*Prefix: Mr.   Mrs.   Ms.   Dr.   Other
*Name:
        Last           First           M.I.
Title:
Business phone:
( ) ( )
Country code City Code Phone Number
Business fax:
( ) ( )
Country code City Code Phone Number
Cell Phone:
( ) ( )
Country code City Code Phone Number
*Primary e-mail:
Other contact information:
ADULT 2
Relationship to Applicant:
Relationship to Adult 1:
Occupation:
Business Name:
Business Address (line 1):
Business Address (line 2):
City:
State/Province:
ZIP/Postal Code:
Prefix: Mr.   Mrs.   Ms.   Dr.   Other
Name:
        Last           First           M.I.
Title:
Business phone:
( ) ( )
Country code City Code Phone Number
Business fax:
( ) ( )
Country code City Code Phone Number
Cell Phone:
( ) ( )
Country code City Code Phone Number
Primary e-mail:
Other contact information:
CUSTODIAL INFORMATION
Check all that apply: Parents separated   Parents divorced   Father remarried   Mother remarried
Where should admission materials be sent? Household 1   Household 2   Households 1 & 2
Other:
If parents are separated or divorced, who has legal custody of the applicant?
 
Please explain custodial living arrangements (e.g., Applicant resides at "Household 2" every other weekend.):
 
HOUSEHOLD 2
Please provide the following information about parents/guardians who do not reside at the applicant's primary residence.

Is this a secondary residence for the applicant?
Yes, this is the applicant's secondary residence.     No, this is not the applicant's secondary residence.

NOTE: Admission material is sent to HOUSEHOLD 1 unless otherwise indicated in Custodial Information section.
Address (line 1):
Address (line 2):
City:
State/Province:
ZIP/Postal Code:
Home phone:
( ) ( )
Country code City Code Phone Number
Home fax:
( ) ( )
Country code City Code Phone Number
Cell Phone:
( ) ( )
Country code City Code Phone Number
Other contact information:
PARENTS/GUARDIANS OF HOUSEHOLD 2
Please provide the following information about the parents/guardians who reside at this address.
ADULT 1
Relationship to Applicant:
Primary e-mail:
Prefix: Mr.   Mrs.   Ms.   Dr.   Other
Name:
        Last           First           M.I.
ADULT 2
Relationship to Applicant:
Primary e-mail:
Prefix: Mr.   Mrs.   Ms.   Dr.   Other
Name:
        Last           First           M.I.
SIBLINGS
First and Last Names Gender Age
OTHER RELATIVES
Please list the applicant's relatives who currently attend, have attended, or graduated from HPA.
First and Last Names Dates Attended Relationship to applicant
EDUCATIONAL/PERSONAL HISTORY
Please list the schools the applicant has attended.
*School *Location *Dates Attended *Grade Levels/Forms
Has the applicant ever (explain all "yes" answers below):
Been promoted a grade? Yes     No
Repeated a grade? Yes     No
Participated in an accelerated program? Yes     No
Been diagnosed with a learning difference? Yes     No
Received any classroom accommodations? Yes     No
Been given an Individual Education Program (IEP)? Yes     No
Had psycho-educational testing (e.g., WISC, Woodcock Johnson, etc.)?
If yes, mail a complete copy of the test results or IEP and analysis and authorize
examiner to communicate directly with HPA regarding the applicant's file.		 Yes     No
Been subject to serious discipline, placed on academic or social probation,
been expelled, or required to withdraw from any school?		 Yes     No
Had any counseling? If yes, please authorize examiner to communicate
directly with HPA regarding the applicant's file.		 Yes     No
Been involved in any legal action including adjudication, probation or pending legal
charges? If yes, mail any supporting legal documentation and explain details below.		 Yes     No
Enter explanations below
MEDICATIONS/ALLERGIES
Please list any medications the applicant is taking. Also include the purpose of the medication, how long the applicant has been on the medication, the dosage, and any medication changes within the past year.
Please list all allergies (including food allegies) and medical conditions (such as diabetes, severe asthma, epilepsy, etc.).
PASSIONS/INTERESTS
What are the applicant's passions or interests in performing arts, visual arts, sports, or other interests/hobbies?
PARENT/GUARDIAN COMMENTS
Please comment on your expectations of how Hawai'i Preparatory Academy may help to build a successful experience for your child and the school. Provide significant details of the applicant's educational career including any recognition, awards, or set backs in previous academic experiences. Include any specific academic, learning or social programs you feel would be beneficial for us to know.
PERSONAL CHALLENGES
Understanding each student as an individual is perhaps the most important commitment we make. Your perspective and input are invaluable as we strive to honor that commitment. It would help us to know of any personal challenges (divorce, family death, etc.) that might have affected the applicant.
By submitting this application form, you are agreeing to the following statements:
• I understand that if accepted, final enrollment of the applicant is based on successful completion of the current academic year and submitting complete official transipts.
• I understand that HPA reserves the right to withdraw acceptance if end of year academic performance does not meet the school's standards.
• I affirm that we have fully disclosed all pertinent information concerning the applicant. I understand that HPA reserves the right to withdraw acceptance if any significant information has been withheld during the admission process that would affect the admission decision.
• I affirm that the information contained in this application and all supporting documenation is true and accurate to the best of our knowledge.