top of page

Home
About Us
School
- Admissions
Recovery Services
Donate
Luncheon
Contact
- Jobs/Volunteer
More...

Use tab to navigate through the menu items.

Enroll at Heartland High School

Please complete the information below to start the application process. Once submitted, our staff will contact you.

For further assistance or questions, email info@heartlandhighschool.org

Student Information

First Name*

Last Name*

Date of Birth*

Sex*

Grade*

Address*

City*

State*

Zip Code *

Cell Phone Number*

Email*

Last School Attended*

Does the student currently use substances or have a history of substance use? Please briefly explain. *

Parent/Guardian Information

First Name*

Last Name*

Relationship to Student*

Cell Phone*

Work Phone

Email*

Address (If Different From Student)

City

State

Zip Code

Parent/Guardian 2

First Name

Last Name

Relationship to Student

Cell Phone

Work Phone

Email

Address (If Different From Student)

City

State

Zip Code

LifeLeap_Logo_Horizontal (1).jpg

QUICK LINKS

(614) 947-1115

Screenshot 2024-12-12 130317.png

© 2024 Heartland High School. All rights reserved | Terms of Use | Privacy Policy

bottom of page