SPLASH! Spanish Language Immersion Program 2021-2022 First Grade Application
Bethany Elementary, and Stoneville Elementary Schools are accepting applications for first grade students for their Spanish Language Immersion Programs. Students will be placed in the program in the order in which the applications are received until the class is full. If a student is not selected, he/she will be placed on the waiting list. If applying for more than one child, please complete a separate application for each child.
PLEASE COMPLETE ALL INFORMATION BELOW
* Required
Email address
*
Your email
Student Name
*
Your answer
Gender
*
Choose
Male
Female
Race
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Parent / Guardian Name(s)
*
Your answer
Address (Street, City, State, Zip Code)
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Work phone
Your answer
What is the primary language spoken at home?
*
Your answer
Attendance Zone School Assignment:
Your answer
1st Choice
*
Choose
Bethany Elementary-Full Immersion Program
Stoneville Elementary-Full Immersion Program
South End Elementary - Full Immersion Program
2nd Choice
*
Choose
Bethany Elementary
Stoneville Elementary
South End Elementary
3rd Choice
Choose
Bethany Elementary
Stoneville Elementary
South End Elementary
Are you an employee of Rockingham County Schools?
*
Choose
Yes
No
Does the applicant have a sibling in the SPASH! Program?
*
Choose
Yes
No
How did you hear about the immersion program?
Your answer
Name of Individual Completing This Form
*
Your answer
*If you have any questions, please contact Nancy Towler*
Phone: 336-627-2600
Email:
ntowler@rock.k12.nc.us
A copy of your responses will be emailed to the address you provided.
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