JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
SPLASH! Spanish Language Immersion Program 2026-2027 First Grade Application
Bethany Elementary and Stoneville Elementary 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
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Email
*
Your answer
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
Stoneville - Full Immersion Program
Bethany Elementary - Full Immersion Program
2nd Choice
Choose
Stoneville - Full Immersion Program
Bethany Elementary - Full Immersion Program
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 Lisa Miller*
Phone:
336-634-3209
Email:
lmiller2@rock.k12.nc.us
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of rock.k12.nc.us.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
