Background: The South West Khasi Hills District of Meghalaya, India, is among the most disaster-prone regions in Northeast India, regularly exposed to earthquakes, landslides, flash floods, and cyclonic winds due to its complex geomorphology and geological settings. Despite heightened vulnerability, systematic Disaster Risk Reduction (DRR) education within formal school settings remains critically underdeveloped. Objectives: This study examines the effectiveness of school-based DRR familiarization programs in enhancing disaster preparedness knowledge among secondary school students in the district. Methods: Using a quasi-experimental pre-test/post-test research design, data were collected from 376 students across eight purposively selected schools. Structured questionnaires, direct observation, and focus group discussions constituted primary data collection instruments. Paired sample t-tests, one-way ANOVA, chi-square tests, and multiple linear regression analyses were employed. Results: Post-program DRR knowledge scores increased significantly (pre-mean = 2.12; post-mean = 3.76; t = 22.47, p < 0.001). The familiarization program demonstrated statistically significant improvements across all six knowledge domains, including hazard identification, evacuation procedures, first aid basics, early warning systems, risk mapping, and community response. Grade level (F = 19.84, p < 0.001) and school type were significant moderating variables. Multiple regression revealed that pre-program knowledge (β = 0.38), grade level (β = 0.22), and participation duration (β = 0.19) were the strongest predictors of post-program learning outcomes (R² = 0.579). Conclusion: Structured DRR familiarization programs embedded within the school curriculum are highly effective in building resilience competencies among students in disaster-prone hill districts. Policy recommendations include institutionalizing DRR modules within the formal curriculum, training teachers as DRR facilitators, and establishing school disaster management committees.