MHPSAS Enrollment Form
NOTE:  This submission is a short interest form that requires more information. Once this form is submitted, we will contact you for next steps. Main Office phone is 231.830.3703.
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Email *
Were you referred to our school by someone?  *
If yes, please provide the name and Phone Number of the person or source of referral.
 *
School Year *
Please select the school year in which your student will begin attending.
Student Information
Student's legal name is required as listed on the Birth Certificate.  (First Middle Last) *
Complete Home Address - House number, Street, City, State & Zip Code *
Primary Telephone Number *
(Please Use Format:  ###-###-####)  This can be a number to receive text alerts.
Student Cell Phone Number
(Please Use Format:  ###-###-####)  
Birthdate *
MM
/
DD
/
YYYY
Gender *
Please select F for Female or M for Male
Grade Entering

 *
Does your child receive special educational services? *
What is the primary language used in your home? *
Is your student Hispanic or Latino? *
What is your student's race? (Please check all that apply) *
Required
Does your family reside in permanent housing? *
Previous School Attended with City, State & Zip *
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