Hope Middle School Admissions Application

HOPE PARTNERSHIP SCHOOL
2601 North 11th Street, Philadelphia, PA 19133

(215) 232-5410 | www.hope-partnership.org
APPLICATION FOR MIDDLE SCHOOL ADMISSION

Please complete all information by typing in space provided. If you have questions about completing this application, please call the school or send email to admissions@hope-partnership.org.
Application for school year*
Click down arrow for school year
Grade applying to
Click down arrow to choose grade
How did you hear about us?
STUDENT INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Parent's/Guardian's Email Address*
example@example.com
Student's gender

malefemaleotherPrefer not to say
Student's birthdate*

MonthDayYear
Choose date
Student's living arrangement*
Choose answer
SCHOOL HISTORY
Student's current grade*
Choose answer
Please list all schools applicant has attended and grade when enrolled*
Does your child have an IEP? *
Yes/No
Is your child receiving speech or occupational therapy? *
Yes/No
Has the student ever been evaluated for, or received, services such as reading and math improvement, English as a Second Language (ESL), social services? *
Yes/No
Please explain:
FAMILY INFORMATION
Does student have sisters, brothers or other family members who currently attend Hope Partnership School? If "Yes", please list student's name and relationship to applicant.

YesNo
Parent/Guardian 1 Name:*
First name, last name
Address, if different from student:*
Employer and Occupation
Parent/Guardian 2 Name:
First name, last name
Address, if different from applicant
Employer and Occupation
Guardian Information*
Total number of children in household, including student*
Click on arrow for response
Names and ages of student's siblings if living in household*
PERSONAL INFORMATION

Hope Partnership School asks for personal, family, and financial information for the purpose of responding to information requests by entities that financially support the school's programs, such as Federal or State agencies or foundations. No personally identifiable information is provided to funding agencies. This sheet is filed separately from the Application for Admission.
The student's racial/ethnic background is: (select all that apply)

Black/African AmericanAsian/Asian-AmericanWhite/CaucasianNative American/HawaiianHispanic/LatinoMixed Race/EthnicityOther
Does this student have any condition that might impact his or her participation in Hope's academic programs, physical education, or extra-curricular activities?*

YesNo
If yes, please describe the assistance required:
Does this student require special assistance or accommodations to complete the school admissions process, to attend Hope Partnership School, or to participate in its programs?*

YesNo
If yes, please describe the assistance required:
How will the student travel to school?

WalkCarPublic transportation
FINANCIAL INFORMATION

Hope Partnership School offers scholarship assistance to families to make the cost of private education affordable. For Hope to make decisions about scholarships, families are required to submit proof of income when officially admitted into the school. Acceptable income documents include your last Federal Income Tax return, Social Security, SSDI, public assistance award letter, or final end of the year pay stub.
NON-DISCRIMINATION STATEMENT

Hope Partnership School firmly adheres to a policy of nondiscrimination in its admissions process and in the administration of its educational programs. Discrimination based on race, color, nationality, religion, ethnic origin, gender, sexual orientation, ability, disability or other characteristics is unlawful and is not practiced by Hope Partnership School.
SIGNATURE AND AFFIRMATION

I certify that the answers given on this application are true and complete to the best of my knowledge. I also authorize investigation of all information contained in this application as may be necessary in arriving at an admissions decision. In the event of my child's admission to Hope Partnership School, I understand that false or misleading information given in this application or interview(s) may result in dismissal from the school.
Parent/Guardian Name
Full name
Date signed

MonthDayYear
Click calendar to choose date
Hope Partnership School firmly adheres to a policy of nondiscrimination in its admissions process and in the administration of its educational programs. Discrimination based on race, color, nationality, religion, ethnic origin, gender, sexual orientation, ability, disability or other characteristics is unlawful and is not practiced by Hope Partnership School.
Should be Empty:

HOPE PARTNERSHIP SCHOOL

2601 North 11th Street, Philadelphia, PA 19133

APPLICATION FOR MIDDLE SCHOOL ADMISSION

STUDENT INFORMATION

SCHOOL HISTORY

FAMILY INFORMATION

PERSONAL INFORMATION

FINANCIAL INFORMATION

NON-DISCRIMINATION STATEMENT

SIGNATURE AND AFFIRMATION