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