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The HUB Houston

Admission Inquiry

The HUB Houston was co-created in 2015 by two very inspired individuals with many years of experience teaching the neurodiverse community. Colleen Russo and Melanie Krause, along with the HUB staff, provide a relationship-centered educational program to serve teenagers and young adults. Each person is Heard, Understood and Believed in. Please request an appointment to tour any of the three HUB Houston facilities. We look forward to the opportunity to serve your family.

Student Details

Welcome to The HUB Houston! Thank you very much for your interest, and we look forward to meeting you in the near future. Please take a few minutes to fill out the information below, as it will help us learn more about your child.

Student Information

First Name^*

Last Name^*

Date of Birth (or due date)^*

Gender^*

School Year Applying for^*

Current Grade / Program Enrolled In

Current School Enrolled In

Grade / Program Applying to ^*

Parent/Guardian Information

Title^*

First Name^*

Last Name^*

Relationship to Applicant^*

Email^*

Phone^* (Primary Contact Number)

Phone Type^* (Primary Contact Type)

Address

Address Line 1^*

Address Line 2

City^*

State^*

Zip^*

Country^*

Sibling Information

Do you have a sibling who is currently attending or had attended our school in the past?

Currently attending

Attended in the past

First Sibling Name

First Sibling Year Attended

Second Sibling Name

Second Sibling Year Attended

Questionnaire

Medical/Diagnoses Information

Please give information as complete as space will allow. Attach an additional page if more space is needed.

Functionality/Diagnoses *

Reason for Search *

Are You Being Treated Now or in the Past by a Psychiatrist, Psychologist, Therapist? *

If a Professional Referred You to The HUB Please Enter Their Name Here. *

Hobbies or Interests? *

Any Triggers We Should be Aware of? (Such as loud noises, thunder, crowds) *

Tour Schedule

SCHEDULE AN APPOINTMENT

Tour Name

Comments/Questions

How did you hear about us?

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3467011714

[email protected]

4209 Galway Lane, Houston, TX 77080