Apply for Enrollment – Student

Please submit this form once per child.

Student Information

Parent / Guardian name

Enter the name of the parent or guardian associated with this child.

Full Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

Grade Level Applying For(Required)

Home Address (if different from parent / guardian)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Language Spoken at Home(Required)

Current School (if applicable)

Academic & Behavioral History

What has your child's education looked like thus far?

Please list any schools, homeschool or hybrid programs, co-ops, etc. If your child has been primarily homeschooled please describe how you homeschool (ex: we use a structured program like Seton, we use a variety of Charlotte Mason materials, we unschool, etc.).

Does your child have an IEP, 504 Plan, or other learning support needs?(Required)

If yes, please explain:

Has your child ever been suspended, expelled, or had behavioral concerns in a previous school setting?(Required)

If yes, please explain:

What are your child’s academic strengths and areas for growth?

What extracurricular activities or interests does your child have?

Is there anything else you would like us to know about your child?

Health & Medical Information

Does your child have any allergies, medical conditions, or special dietary needs?(Required)

If yes, please explain:

Physician’s Name & Contact Information(Required)

Health Insurance Provider & Policy Number(Required)

Questions?

Reach out via email at admin@motherofhopehybridacademy.org

Growing in Faith & Reason, Wisdom & Grace

Fides et Ratio, Sapientia et Gratia.

Mother of Hope Hybrid Academy is a faith based educational non-profit which supports homeschooling families.

Mother of Hope Hybrid Academy at St. Ursula’s
1301 Sioux St., Fountain Hill, PA 18015