HCSS Admission Form
For the translation: https://goo.gl/1yH1qX

DEAR PARENT(S) AND APPLICANT: Thank you for your interest in Hampden Charter School of Science, (HCSS). Please fill out this application form completely. Information you supply may not be given to any other companies. Applications received unsigned or incomplete may not be considered for acceptance.

The primary districts that HCSS serve:

Agawam,  Chicopee, Holyoke, Ludlow, Springfield, West Springfield, and Westfield

Students who live in these districts receive admission preference. Any resident of Massachusetts, including students who may be homeless, are eligible to apply and to attend HCSS.
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To which year are you applying? *
To which grade are you applying? *
To which school are you applying? *
Student Information
First Name *
Middle Name
Last Name *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Current School *
Current Grade *
Home Address *
City *
State *
Zip *
Primary Parent Information
Primary Parent Name *
Primary Parent Relation to Student *
Primary Parent E-mail *
Primary Parent Phone *
Secondary Parent Information
Secondary Parent Name
Secondary Parent Relation to Student
Secondary Parent E-mail
Secondary Parent Phone
Complete and Submit the Application!
Does the applicant have a sibling* who currently attends HCSS? *
*Sibling preference for admission is only applies to students who share a common parent through birth or legal adoption. Students must provide documentation (i.e.: birth certificate, legal records) to receive preference. Sibling preference will only be applied for the campus which the sibling attends.
If yes, Name(s) and Grade
How did you hear about HCSS *
Non-Discrimination Statement
In accordance with M.G.L. c. 76, s. 5, Hampden Charter School of Science shall not discriminate nor tolerates harassment based on race, color, national origin, creed, sex, ethnicity, gender identity, sexual orientation, mental or physical disability, age, ancestry, athletic performance, special need, proficiency in the English language or a foreign language, or prior academic achievement. Hampden Charter School of Science has a zero tolerance for harassment based on these areas.
A school may not require any action by a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for an applicant to either receive or submit an application for admission to that school.
*
We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.
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