Student Enrollment Application
Mother Hannah School
Join Our Community of Excellence
Student Information
First Name
*
Middle Name
Last Name
*
Suffix
Preferred Name
Date of Birth
*
Gender
Select Gender
Male
Female
Nonbinary
Other
Student Email Address
*
This will be used for the student portal
Grade Level
*
Select Grade
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Graduation Year
Race / Ethnicity
Nationality
Home Language
Enrollment Type
New Student
Transfer Student
Returning Student
Previous School Information
Previous School Name
School Location (City/State)
Dates Attended
Reason for Leaving Previous School
Guardian Information
Primary Guardian
Full Name
*
Relationship
*
Select
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Legal Guardian
Other
Preferred Language
Cell Phone
*
Home Phone
Email Address
*
Secondary Guardian (Optional)
Full Name
Relationship
Select
Mother
Father
Grandmother
Grandfather
Legal Guardian
Other
Custody Information
Select
Full Custody
Joint Custody
Limited Custody
No Custody Rights
Cell Phone
Work Phone
Email Address
Emergency Contact
Emergency Contact Name
*
Relationship
*
Phone Number
*
Health & Medical Information
Primary Physician Name
Physician Phone Number
Health Insurance Provider
Policy Number
Group Number
Allergies (List all with severity level)
Medical Conditions
Current Medications
Emergency Medical Treatment Authorization
*
Please Select
Yes, I authorize emergency medical treatment
No, I do not authorize emergency treatment
Limited authorization (contact first if possible)
This authorization allows medical professionals to provide emergency care if parents cannot be reached immediately.
Academic Information
Special Education Services
No special services
Yes - IEP (Individualized Education Program)
Yes - 504 Plan
Gifted and Talented Program
Speech Therapy
Other Services
English Language Learner Status
Select Status
Native English Speaker
Fluent in English (Second Language)
Developing English Proficiency
Beginning English Learner
Agreement & Submission
I confirm that all information provided is accurate and complete. I understand that this application will be reviewed by the admissions team and I will be contacted regarding the enrollment status.
What happens after submission:
Your application will be reviewed by our admissions team
You'll receive an email confirmation with login credentials
We'll contact you within 2-3 business days about your application status
Upon approval, you'll gain access to student and parent portals
Submit Enrollment Application