Brooklyn New School, PS 146 Pre-K Outreach Questionnaire
Brooklyn New School is in year four of a new admissions policy designed to help foster diversity within the school. The DOE will prioritize low income students. You can indicate on this questionnaire if your family qualifies as low income.
Pre-K Outreach Questionnaire for September 2019
This is NOT an application. This survey will help us with our outreach. Please fill out a separate survey for each child. Go to the DOE website for the pre-K application and more information about the pre-K application process.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's address *
Your answer
apt. #
Your answer
zip code *
Your answer
birthday *
mm/dd/yyyy
Your answer
Gender pronouns parents / guardians would like us to use with their child
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Home Phone *
xxx-xxx-xxxx
Your answer
Cell phone
xxx-xxx-xxxx
Your answer
email # 1
Your answer
email # 2
Your answer
Current school
if applicable
Your answer
Does your family qualify as low income?
2017-2018 USDA Income Eligibility Guidelines. In order to qualify as low income your household income must be within the limits defined by the 2017-2018 SY USDA Income Eligibility Guidelines. Please see below for an example of the Reduced Income Eligibility Guidelines: https://docs.google.com/spreadsheets/d/1u6QQVuHS82DaH7expNXEiNsWmvyrkN_8yjG12xyM36U/edit?usp=sharing
If student has siblings attending BNS or BCS, please list sibling's first and last name:
Your answer
If student has siblings attending BNS or BCS, please list sibling's grade in Sept 2019:
Your answer
If student has siblings applying to BNS or BCS, please list sibling's first and last name:
Your answer
If student has siblings applying to BNS or BCS, please list sibling's grade in Sept 2019:
Your answer
How did you hear about BNS?
check all that apply
Languages spoken at home
Your answer
Is student in a bilingual program?
Your answer
Is student in an ESL program?
Your answer
How many people live in your household?
Your answer
Do you receive SNAP or TANF benefits?
Was your child adopted?
Is this child in a foster home?
Does your child currently have an Individualized Educational Plan or IEP?
If yes, does your child's current IEP include any of the following recommendations?
Does your child's IEP include any of the following?
Do you expect your child to have an IEP in the upcoming school year?
If yes, indicate the possible recommendation:
Please indicate services the IEP might recommend:
Does your child have any needs that may require special help or attention in school?
If yes, please check all that apply:
Notes for the admissions department
Your answer
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