Cypress College Prep Student Application Form Cypress College Prep Student Application Form Date of Application* DD slash MM slash YYYY Term*Please Select the term you are applying for from the drop down menu belowFall 2022Spring 2023Fall 2023Spring 2024Student InformationStudent Name (as appears on transcripts)* First (Given Name) Middle Last (Family Name) Preferred Name (if any) Student's Date of Birth* DD slash MM slash YYYY Gender*FemaleMalePrefer other gender descriptionExpected Year of Graduation*202320242025202620272028Grade applying for:*12111098I have finished high school in my home country and would like to come for a college preparatory yearStudent Email* Student Phone*Parent InformationWho does the student currently live with?* Both Parents Mother Father Boarding School Other relative or guardian Father's Name* First Last Father's Email* Father's Employer Father's Mobile Phone*Mother's Name* First Last Mother's Email* Mother's Employer Mother's Mobile Phone*Student's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code We would like to thank the person who referred you to HBA so please type their name below.We would like to thank the person who referred you to HBA so please type their name below. Photo Release*From time to time we take pictures of class activities to post on our website or Facebook page. We would appreciate it if you would allow use to your child's image (no names) without prior consent. I agree to allow my child to be photographed for promotional purposes on our website, Facebook page, or printed materials Academic HistoryName of current or most recent school:* City and State of Current School? Which grades did you attend at your current school? Current or most recent grade level:* Please list any other schools attended in grades 9 through 12:Transcripts*Please upload your student's transcripts for grades 9 through 12. If applying for grade 9, upload transcripts for grades 7 and 8. Transcripts may also be emailed to: studyhut@highbluffacademy.comMax. file size: 50 MB.HBA Student Contract FormMax. file size: 50 MB.Class schedule*Please upload your student's class schedule/timetable.Max. file size: 50 MB.Is there any information you would like to share with us about your child?Special Needs*Does your child have any of the following that you know of:NoneHistory of Substance AbuseLearning DisabilityHealth concernADD/ADHDHistory of defiant behaviorAnxiety and/or DepressionOther mental illnessExplainIf you checked any of the above, please give a brief description below:Has the student been expelled or asked not to continue at any other school? If yes, please explain the circumstances.*Has the student ever been arrested and/or put on probation? If yes, please explain below.*Immunization Record*The State of California requires certain immunizations to attend school. Please upload your child's immunization records and we will notify you of any additional vaccinations that are required if your child chooses to attend HBA. These records may also be emailed to: admissions@highbluffacademy.com once the student is admitted.Max. file size: 50 MB.Application SignatureElectronic Signature*By typing your full name below, you assert that all information on this application is true to the best of your knowledge. CAPTCHA Δ
