Do you need credit retrieval /Necesitas acceder a creditos? *
Student Full Name /Nombre del estudiante *
Your answer
Home Address/Direccion de casa *
Your answer
City/Ciudad *
Your answer
Zip Code/Código Postal *
Your answer
Student School/(Lunch) ID # / Número de Estudiante/Número del almuerzo *
Your answer
Birth Date / Fecha de nacimiento *
MM
/
DD
/
YYYY
Student's NHPS Email/ NHPS Email del Estudiante *
Your answer
Preferred Language/ Lenguaje preferido *
Phone Number / Número de Teléfono *
Your answer
Parent/Guardian Name / Nombre del padre/ Encargado *
Your answer
Parent/Guardian Email / Correo electrónico del padre/ Encargado *
Your answer
Parent/Guardian Phone Number / Número de Teléfono del padre/ Encargado *
Your answer
Emergency Contact First Name / El Primer Nombre del Persona de emergencia *
Your answer
Emergency Contact Last Name / Apellido del Persona de emergencia *
Your answer
Emergency Phone Number / Número de Teléfono de emergencia *
Your answer
Current Grade / Grado Actual *
Choose
Grade 9
Grade 10
Grade 11
Grade 12
Where are you currently enrolled? HS en el que estás inscrito *
Choose
936411 Cooperative Arts HS
931711 Engineering & Sci
936311 Hill Regional Career
936611 HSC
936211 James Hillhouse
936011 Metropolitan
937011 New Haven Academy
939111 Riverside
936711 Sound
936111 Wilbur Cross
Please list all of your allergies/ Por favor liste las alergias
Your answer
Do you have any medical or health conditions that may interfere with your participation? / Tiene alguna condición médica? *
Please list any of your medical conditions that may interfere with participation in the summer program / Por favor mencione las condiciones medicas que puedan interferir con la participación en el programa.
Your answer
Please select the course needed *
Required
School Counselor Name *
Your answer
Who Completed this Application?/ Quién está completando esta solicitud. *
Choose
Self(Student)/Estudiante
Parent/Padre
Guardian
School Counselor
Other:
Full Name of Person who completed this application/ Nómbre de la persona que está completando *
Your answer
A copy of your responses will be emailed to the address you provided.