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 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
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
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.
Would you like to receive Financial Aid Information? Yes No
Would you like information about our homestay program? Yes No
Arts Art Choir Drama Instrument Music
Athletics Soccer Volleyball Basketball Baseball Softball Golf
Activities Hunting Skiing/Snowboarding Hiking Technology Publications
