Application 2017-2018 (English)
This is an application for potential Kindergarten through 8th grade seats at BSNBCS. ***Students must be age 5 by December 31st, 2017 - students born in 2013 will not be accepted.

82 Lewis Ave, Brooklyn, NY 11206
p: (718) 453-1001. f: (718) 452-2090

STUDENT INFORMATION
Student's First Name
Your answer
Student's Last Name
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Grade applying to for the 2017/2018 school year
Current Grade
Student Home Address
Your answer
Student apt #
Your answer
Student City
Your answer
Student State
Your answer
Student ZIP Code
Your answer
Current School Name (if applicable)
Your answer
SIBLING INFORMATION
Does the student have a sibling already ATTENDING Bedford Stuyvesant New Beginning Charter School
If yes, what is the Sibling's name (or names)?
Your answer
Does the student have a sibling APPLYING to Bedford Stuyvesant New Beginnings Charter School for another grade?
If yes, what is the Sibling's name (or names)?
Your answer
If yes, what is the Grade that the sibling is applying to?
PARENT/GUARDIAN INFORMATION
Name of Parent/Guardian
Your answer
Relationship to Student
Your answer
Cell Phone
Your answer
Home Telephone
Your answer
Work Telephone
Your answer
Email
Your answer
Home Address
Your answer
Apt #
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Name of 2nd Contact Person
Your answer
Relationship of 2nd Contact Person to Student
Your answer
2nd Contact Cell Phone Number
Your answer
2nd Contact Home Phone Number
Your answer
2nd Contact Email
Your answer
OTHER INFORMATION AND ATTESTATIONS
How did you find out about BSNBCS?
Your answer
What is your Community School District (CSD)?
Your answer
Affirmation Statement
I agree that the school records of the student for whom I am submitting this application may be used for studies of this charter school. Bedford Stuyvesant New Beginnings Charter School will not discriminate against any student, employee, or other person on the basis of national origin, ethnicity, gender, disability or any other ground that would be unlawful if done by any other public school.

I understand that to be eligible for admissions preferences, I must submit proof of legal guardianship. Failure to do so will result in my application being ineligible for these preferences.

Parent signature (type your name below if you agree)
Your answer
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