HATS ApplicationStudent First NameStudent Last NameBirthdateBirthdateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember1234567891011121314151617181920212223242526272829303120212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Sex:Sex:FemaleMaleOtherPrefer not to answerIs the student Hispanic or Latino?Is the student Hispanic or Latino?YesNoPrefer not to answerStudent Race (check all that apply):Student Race (check all that apply):American Indian or Alaska NativeAsianBlack or African AmericanHispanicNative Hawaiian or Other PacificWhiteOtherPrefer not to answerGrade Level Fall 202012th Grade11th Grade10th Grade9th Grade8th Grade7th Grade6th Grade5th Grade4th Grade3rd Grade2nd Grade1st GradeKindergartenName of SchoolSchool DistrictHomeschoolDoes your child qualify for the National School Lunch Free or Reduced –Priced Lunch Program?Does your child qualify for the National School Lunch Free or Reduced –Priced Lunch Program?YesNoContact InformationParent First Name:Parent Last NameEmail AddressBest Contact Phone NumberAdditional Contact Phone NumberMailing AddressMailing AddressCountryStreetCityRegionPostal CodeRegistration EligibilityHas the student attended HATS classes before?YesNoWhen?Has the student scored at the 95th percentile or higher on any standardized testing?YesNoDoes the student participate in a gifted program?YesNoEligibility RequirementsIf you answered “No” to all of these questions, you may submit a TEACHER RECOMMENDATION. Please provide the name and school email address of the recommending teacher below.If you answered “No” to all of these questions, you may submit a TEACHER RECOMMENDATION. Please provide the name and school email address of the recommending teacher below.Teacher First Name:Teacher Last Name:Email AddressEmergency InformationEmergency Contact Name:Relationship to Student:Emergency Contact AddressEmergency Contact AddressCountryStreetCityRegionPostal CodeEmergency Contact Email AddressEmergency Contact Phone NumberStudent AllergiesOther Medical or Accessibility NeedsSignatureBy checking this box - I have read and agreed with the HATS Program Informed Consent.2019-20 HATS Program Online Informed Consent FormSubmit
