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The Hathaway Institute
Enrollment Application
Student Full Name
*
Birthday
*
Month
Day
Year
Multi-line address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Parent/Guardian Full Name
*
Parent/Guardian Full Name
Email Address
*
Grade Level For 2026-2027 Academic Year
*
7th (Lower School)
8th (Lower School)
9th (Lower School)
10th (Upper School)
11th (Upper School)
12th (Upper School)
Home Phone Number
*
Current School District And School During 2025-2026 Academic Year
*
Sexual Orientation And Gender
Female
Male
Personal Statement: Please describe your honors, special recognitions, academic goals, career aspirations, and how enrolling in the institution will impact you academically.
Tentative Dates For Parent/Guardian-Student-Administration Screening Meeting (Include Up To Three (3) Dates And Times)
Emergency Contact Person Name (1)
*
Emergency Contact Person Number (1)
*
Emergency Contact Person Name (2)
Emergency Contact Person Number (2)
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