HSADV ONLINE APPLICATION FORM 2012-2013

Student Information:

First Name
Middle Name
Last Name
Date of birth
Address
Zip Code
Home Phone#
Other Phone#	Describe

Grade Applied For
Current School
Current District

Does the applicant have a sibling who's attending this school?
Does the student have any documented history of a criminal offense or juvenile court adjudication?
If yes, please explain:
Do you consent to the release of directory information about the student named above outside the Harmony Public School System to sources such as an institution of higher education or newspapers and other media, except as authorized by law?

Parent/Guardian Information:

First Name
Last Name
Email

We/I, the undersigned, hereby certify that, to the best of our/my knowledge and belief, the answers to the foregoing questions and statements made by us/me in this application are complete and accurate. We/I understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.

NON-DISCRIMINATION STATEMENT: It is the policy of Harmony School of Advancement to comply with all state and federal regulations regarding admission and not to discriminate during the admission and the lottery process on the basis of gender, national origin, ethnicity, religion, disability, academic, artistic, athletic ability, or the district the child would otherwise attend.