2019 -2020 Student Application
Email address *
Name (First, Last)
Date of Birth (MM/DD/YYY)
Clear selection
Home Address (Street address, apartment number, city, state, zip code)
NYC Community School District, if Known
Grade Applying for:
Clear selection
Previous School (2018-19)
Sibling Preference: Do you currently have a child enrolled at Heketi? If yes, please include name
Parent Name
Relationship to student
Home Address (if different)
Phone number
Email Address
What primary language spoken at home?
Signature and date
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