HIPPY & HIEPE Programs Interest Form 
Thank you for your interest in the HIPPY & HIEPE Programs. Please note that this form does not guarantee placement in the program. The form helps the program identify interest families for placement. If the information you filled out changes, please contact 972-600-6121 to update the information. 
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Parent First & Last Name (Nombre y Apellido del Guardian) *
Student First and Last Name (Nombre y Apellido del Estudiante) *
Student Date of Birth (fecha de nacimiento del estudiante) *
MM
/
DD
/
YYYY
What is your child's ethnicity? ¿Cuál es la etnicidad de su hijo? *
What is your child's race? ¿Cuál es la raza de su hijo? *
Address (dirección) *
Phone Number (Número de teléfono) *
What language do you prefer the materials? (¿En qué idioma prefiere los materiales?) *
What is the best day of the week for an instructional visit? (¿Cuál es el mejor día de la semana para una visita de instrucción?) *
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