Parent/Guardian  Student

First Name

Middle Name

Last Name

Suffix
None II III IV Jr. Sr.

Date of Birth

Gender
Female   Male

Home Address 1

Home Address 2

City

State
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Postal Code

Country

International
Yes   No

Ethnicity
Please Select White Black Asian Hispanic American Indian Middle Eastern Multi-racial Pacific Islander

Home Phone

Student E-Mail

Current School

GPA

Current Grade

Year of Proposed Entry

Applying for what Grade Level?
III Form (9th Grade)
IV Form (10th Grade)
V Form (11th Grade)
VI Form/PG (12th Grade)

Boarding/Day?
Boarding   Day

How did you learn about Houghton Academy?

Title
Mr. Mrs. Miss Ms. Dr. Hon. Rabbi Pastor Sen

First Name

Last Name

Suffix
None II III IV Jr. Sr.

Gender
Female   Male

Relationship
Father Mother Stepfather Stepmother Grandparent Uncle Aunt Sponsor Consultant Friend Other

If you selected 'Other' above, please specify

Title
Mr. Mrs. Miss Ms. Dr. Hon. Rabbi Pastor Sen

First Name

Last Name

Suffix
None II III IV Jr. Sr.

Gender
Female   Male

Relationship
Father Mother Stepfather Stepmother Grandparent Uncle Aunt Sponsor Consultant Friend Other

If you selected 'Other' above, please specify

Parent E-Mail

Enter parent address below only if different from above.

Home Address 1

Home Address 2

City

State
Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Postal Code

Country

Would you like to receive Financial Aid Information?
Yes   No

Would you like information about our homestay program?
Yes   No