Please Fill out this form, then return to Enrollment page to Step 4 to pay and complete enrollment.

Return to Enrollment Page

Financial Information

Step 1 of 3

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Family Information

Parent/Guardian 1

Parent/Guardian 1 Name(Required)

First Last

Parent/Guardian 1 Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian 1 Phone(Required)

Parent/Guardian 1 Email(Required)

Parent/Guardian 2

Parent/Guardian 2 Name

First Last

Parent/Guardian 2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian 2 Phone

Parent/Guardian 2 Email

Students

Student 1 Name(Required)

First Last

Student 1 Grade(Required)

Student 2 Name

First Last

Student 2 Grade

Student 3 Name

First Last

Student 3 Grade

Student 4 Name

First Last

Student 4 Grade

Select a Payment Plan(Required)

10 monthly payments from August-May

Payment for the full year in advance (includes a discount)

Financial Assistance(Required)

I DO NOT request EITC funds, scholarships, or financial aid, and will be responsible for all tuition and fees

I WOULD LIKE TO APPLY for EITC funds, scholarships, or financial aid, and will be responsible for all tuition and fees (choices on next page)

Harrisburg Adventist® School

Please Fill out this form, then return to Enrollment page to Step 4 to pay and complete enrollment.

Financial Information

Family Information

Parent/Guardian 1

Parent/Guardian 2

Students

Household Information

Annual Income Information

Monthly Expense Information

Special Circumstances

Tuition Contribution

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