Hanley International Academy
2017-2018 Enrollment Application
Please submit one form for EACH child to be enrolled.
Grade Applying for 2017-2018 (Circle one) K 1st 2nd 3rd 4th 5th 6th 7th 8th
Student's Information - PLEASE PRINT CLEARLY
Students Name: _______________________________________________________________________________
(As printed on Birth Certificate) Last Name First Name Middle Name
Student's Gender Male Female Date of Birth (mm/dd/yyyy) ___________________ City/State of Birth _________________
Student's Ethnicity
Please identify the student regarding ethnicity and race. Failure to do so will result in the school making this determination.
Which of the following groups describes your child's race? (Select all that apply)
American Indian or Alaskan Native Native Hawaiian or other Pacific Islander Asian Caucasian/White Black or African American Hispanic/Latino Other
Parent/Legal Guardian's Information
Parent/Guardian: __________________________________________________ Relationship:_______________________________
Last Name First Name
Home Phone # _______________________________ 2nd Contact # ________________________________
Email Address _______________________________ Highest Grade Level Completed ____ Grade Sch ____High Sch___ College ____
Parent/Guardian: __________________________________________________ Relationship:_______________________________
Last Name First Name
Home Phone # _______________________________ 2nd Contact # ________________________________
Email Address _______________________________ Highest Grade Level Completed ____ Grade Sch ____High Sch___ College ____
Student's Address _____________________________________________________________________________________________
Street Address City State Zip Code
Is the family currently homeless or would be interested in homeless services? YES NO
Student Educational History
Student Born in the US YES NO If NO, what is the student's date of entry to the US _____________
How many years of schooling in the US _______________
Last Grade Completed? K 1st 2nd 3rd 4th 5th 6th 7th 8th
Name of the last school attended ______________________________________________________________
City/State of the last school attended ___________________________________________________________
If your child has ever been expelled from a school YES NO If YES, please list when and give a brief reason: __________________
________________________________________________________________________________________________________
Has your child ever been retained? YES NO If YES, what grade(s)? K 1st 2nd 3rd 4th 5th 6th 7th 8th
This signature represents my permission to request records from any previous educational institution my student attended:
Signature of Parent/Guardian _________________________________________________________________ Date ____________
Student resides with: Both Parents Father Mother Guardian Other _________________________
Does this student have a sibling that is currently enrolled at Hanley International Academy? YES NO
If yes, what is the sibling's name? If there is more than one sibling, you only need to list one name _______________________________
How did you hear about us? Mailing Friend/Relative Website/Internet Previously attended Hanley Other _____________________
Do you need to utilize a school bus? YES NO
Return Application to: 2400 Denton St Hamtramck, Michigan 48212 313-875-8888 phone 313-875-8898 fax
Completed by school personnel only:
Date/Time application was received: _________________ Immunization MCIR# ________________ Waitlist Date/Number _________
Date received: BC _________ Immunization Record ____________ Report Card ________________ UIC ____________________