Dear Parent,

I appreciate again the interest you have shown in Harbert Hills Academy. The following form must be filled out before a student will be accepted.

Harbert Hills Academy focuses on developing the physical, mental and spiritual faculties by offering a balanced program of school, work, recreation, and church. Our “Earn While You Learn” financial plan is developed for parents with limited resources. In our school, you can work and pay for a large portion of your school expenses.

I am inviting you to visit our campus. It would be a pleasure to meet you and your family. We hope that you will choose Harbert Hills Academy.

Name of Student: *
Age of Student: *
Date of Birth:
Social Security Number:
Name of Father:
Name of Mother:
Phone Number: *
Street Address: *
City: *
State: *
Zip Code: *
With whom are you living?:	Father Mother Both Other
Who is responisible for expenses: *	Father Mother Both Other
Do you have any siblings?: *	Yes No
When would you like to begin school?: *	Summer Fall Spring Now
Church Preference?: *	Seventh-day Adventist Other
If other, Please specify::
Racial Origin?: *	Anglo American Afro-American Hispanic Native American Asian Other
If Other, Please specify::
U.S. Citizen?: *	Yes No
Do you have any physical illness or condition that would limit your participation in school?: *	Yes No
If yes, Please specify::
Name of school last attended: *
Highest grade completed:: *	8 9 10 11 12
Year Completed:: *	1998 1999 2000 2001 2002 2003 2004 2005 2006
Which vocation would you prefer?: *	Food Service Building Restoration Auto Mechanics Medical Missionary Architectual Radio Broadcasting Gardening
Student: If I am accepted, I pledge to respect authority and abide by the values of the school?: *	Yes No
Parent / Guardian: We give permission to Harbert Hills Academy to act as substitute parents?: *	Yes No
Attached a picture of Student?:	Yes No
Attach File
* = required field

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