2016-2017 SVCS Application
To apply to the Surry Village Charter School, please complete this form and submit.
Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Complete Mailing Address *
Street, City, State, Zip Code
Your answer
Birthdate *
MM
/
DD
/
YYYY
Town of Birth *
Your answer
Gender *
Current School
Your answer
Current Grade *
Grade Entering 2016-2017 *
If Kindergarten
Is this child currently receiving special education services?
Is this child currently on a 504 plan?
Parent 1 Name *
Your answer
Parent 1 Email Address
Your answer
Parent 1 Full Address (if different from above)
Street, City, State, Zip Code
Your answer
Parent 1 Home Phone
Your answer
Parent 1 Cell Phone
Your answer
Parent 2 Name
Your answer
Parent 2 Email Address
Your answer
Parent 2 Address (if different from above)
Street, City, State, Zip Code
Your answer
Parent 2 Phone (if different from above)
Your answer
Parent 2 Cell Phone
Your answer
Is the child the sibling of a current student?
Please list all siblings applying
Your answer
Statement of Interest *
Please briefly describe your interest in Surry Village Charter School
Your answer
How did you find out about SVCS?
By submitting this form, I agree that the above information is correct, I understand that this application does not guarantee a position for my child at the Surry Village Charter School. I attest that I am the legal guardian for this child and if my child is able to attend SVCS, I will participate in the SVCS plan for academic expectations and parent involvement. I agree to allow SVCS to receive my child’s student records from the sending school district if he/she is enrolled. *
New Hampshire’s Statutes and Rules require that a school district keep accurate records and updated personal files for all pupils. This information will become part of the student's permanent cumulative record and will be available to appropriate staff members and child’s parents. New Hampshire law requires that you provide Immunization information to your child's school.
Thank you for you interest in Surry Village Charter School.
Submit
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