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