Student Application Form
INSTRUCTIONS FOR PARENTS AND GUARDIANS

Please complete this form as accurately and truthfully as possible. Be sure to make a copy and retain for your records. For a list of courses, class schedule, and academic calendar, please visit our website at www.filschool-nynj.org.

Any questions or concerns can be directed to:

Venessa Manzano, School Director
The Filipino School of New York & New Jersey
Email: info@filschool-nynj.org
Phone: 774.257.4669

Maraming salamat for your interest and support!

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STUDENT INFORMATION
NAME *
Last Name, First Name, Middle Initial
DATE OF BIRTH *
MM
/
DD
/
YYYY
GENDER *
MAILING ADDRESS *
Street, Town/City, State, Zip Code
PARENT/GUARDIAN INFORMATION *
Last Name, First Name, Relationship to Student
TELEPHONE NUMBER *
EMAIL *
VENMO, ZELLE, OR GOOGLE PAY UNDERNAME/ACCOUNT *
As a parent/guardian, what do you hope your child will gain from his/her experience at The Filipino School of New York & New Jersey? *
EMERGENCY INFORMATION
Emergency name and telephone number of a responsible adult who will care for the student if the parent/guardian is unavailable:
NAME
Last Name, First Name, Relationship to Student
TELEPHONE NUMBER
EMAIL
Please indicate if the student has any allergies or if you have any special health/medical concerns about the student:
COURSE REGISTRATION INFORMATION
COURSE/PROGRAM NAME *
COURSE/PROGRAM LOCATION *
SEMESTER AND YEAR (i.e. SPRING 2020) *
UNDERSTANDING OF POLICIES *
Yes
No
Liability Waiver: I will not hold The Filipino School of New York & New Jersey, its board of directors, employees, or volunteers responsible for any accidents, injury, or harm incurred during participation in The Filipino School of New York & New Jersey programs and activities. If either the emergency contact or doctor cannot be reached in case of emergency, consent is hereby given that I receive medical treatment.
Health Clearance: My child is in good health and can participate in all school activities.
Attendance: I understand that daily attendance and promptness are required. I must arrange for a responsible adult to bring my child to school and pick him/her up daily. I understand that no transportation is provided.
Consent to Photograph and/or Record: I understand that the images, film,videotape, audio recording, music and/or artwork in which my child will be participating in is being produced by The Filipino School of New York & New Jersey. I hereby acknowledge that my child’s participation may be edited and used in whole or in part as desired, and may be reproduced, duplicated, distributed and used for non-theatrical audiovisual exhibition in schools, colleges, public institutions and other institutions where admission charge is not specifically made, and for general education and public information purposes, without restriction. I also consent to the use of my child’s likeness and voice for information purposes in connection with the images, film,videotape or music recording.
Confidentiality Policy: The information provided on this form is confidential. It is protected by The Family Educational Rights and Privacy Act (1974) and prohibits unauthorized access to student records and unauthorized release of any student record information identifiable by either student name or other personal identifiers.
ACKNOWLEDGMENT & SIGNATURE
I hereby certify that the  above information is true and correct to the best of my knowledge. I acknowledge and understand that the information provided here will be relied upon for purposes of determining my eligibility for this program. I acknowledge that a material misstatement fraudulently or negligently made in this or in any other statement made by me may constitute a federal violation and may result in the denial of participation in this program.
NAME *
Parent/Guardian First Name, Last Name
DATE *
MM
/
DD
/
YYYY
SPECIAL CONSIDERATIONS
Please let us know of any learning styles/needs that we should be aware of in order to support your child.
TUITION PAYMENT
Payment can be made via check (made payable to The Filipino School of New York & New Jersey), Venmo (FilSchoolNYNJ), or Google Pay (filschool.nynj@gmail.com). There is a 10% discount for each additional sibling.

** When using Venmo and selecting "Paying for a good or service", please add an additional 1.9% + $0.10 to the total amount". If you do not select "Paying for a good or service", then no additional transaction fees need to be added.
FINANCIAL ASSISTANCE / NEEDS-BASED SCHOLARSHIP

Through the generosity of an anonymous donor, we are offering two scholarships this semester for those families needing financial assistance with tuition. 

If you are interested, please check off "YES" below. Additional documentation will be required and will be used to determine eligibility. This information will be held in confidence and will not be shared for any other purposes.
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