Application Request Form
Child's Name:
Date of Birth:
Grade Interested In:
Requested Year:
Parent Name:
Alternative Phone:

I acknowledge and understand that the information on this form will be used solely for communications related to the Harambee Institute of Science and Technology Charter School (HISTCS) enrollment process. Submitting this form does not indicate nor confirm acceptance of my student into HISTCS.

I acknowledge and understand:

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AKAN National Day of Service

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