Multi-Student Discount Application General Information Student Names and Grade They Will Be Attending * If new to MHCA, student's previous school: Father's Name First Name Last Name Mother's Name First Name Last Name Mailing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Number Cell Phone Number Church Affiliation Pastor's Name Dependent Information Please list all information for each dependent child who will not be attending MHCA. Include Name, Age, & School. Sources of Income Source and Estimated Income of Each: Please Write Your Full Name in the Box Below: * By typing your name below, you are signing this application electronically. First Name Last Name Date Completed MM DD YYYY Thank you! Your application has been submitted.
