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Summer Session 2010 Application

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Personal Information

Applicant's Name

Full Name of applicant exactly as it appears on birth certificate or passport

Last/Family Name: *

First/Given Name: *

Middle Name:

Nickname (for teachers to use):

Current Grade(or grade/level last completed): *

Student's Email:

Student's cell phone:

Date of Birth: *

Age: *

Gender: *

Male

Female

Place of Birth

City: *

State/Province : *

Country: *

Citizenship (list all): *

Does the applicant require an I-20 form to obtain a student visa?: *

Yes

No

Is the applicant a U.S. citizen?: *

Yes

No

Is the applicant’s mother a U.S. citizen?: *

Yes

No

Is the applicant’s father a U.S. citizen?: *

Yes

No

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Hawaiʻi Preparatory Academy | 65-1692 Kohala Mtn. Rd. | Kamuela, HI 96743 | 808.885.7321
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