Enrollment – HDAA

Student Information

First Name

Last Name

Address

City

State

Zip Code

*Phone

*Email

Detail Information

Birthdate

Gender

*Last 4 of SSN

Your current status

*Graduated from High School

Year Graduated

High School Name

High School Address

City/State/Zip Code

Name at time of graduation

Description of Course

Parent Information (If student is under 18)

Parent/Guardian Name

Address

City/State/Zip Code

Parent Phone Number

Parent Email

Agreement

I hereby attest that the above information is true and correct and acknowledge that acceptance into this academy will be bases, in part on the validation of this information. I also authorize the release of the above information to a third party for the purpose of either verifying the information or obtaining a copy of my high school or equivalency documentation.

If you agree type I AGREE below.

Agreement