NSH 2022-23 Application (Enrollment Form)

Student's Legal Name *

First Name Middle Name Last Name
Gender *

male female
2022-23 Grade level *

9 10 11 12
Student's Birth Date *

Month Day Year
Student's Birth Place (City, State) *
Is your Student Hispanic or Latino? *

Yes No
Your Student's Ethnicity *

American Indian or Alaskan Native Asian Native Hawaiian or Pacific Islander Black or African American White
Student's Address *

Street Address

Street Address Line 2

City

Zip Code
The Student resides with Parent / Guardian #1 (below). *

Yes No
The Student resides with Parent / Guardian #2 (below). *

Yes No
Parent / Guardian Information
1. Parent / Guardian Name *
1. Relationship to the Student *
ex. Father, Mother, etc.
1. Parent / Guardian Phone Number *
xxx - xxx - xxxx
1. Parent / Guardian E-mail *

Confirmation Email
2. Parent/Guardian Name
2. Relationship to the Student
ex. Father, Mother, etc.
2. Parent/Guardian Phone Number(s)
xxx - xxx - xxxx
2. Parent/Guardian E-mail

Confirmation Email example@example.com
What language is spoke at home? *
What school does your Student currently attend? *

School Name

Address

City State

Grade
Does your Student have an IEP (Individualized Education Plan)? *

Yes No
Does your Student have a 504 Plan? *

Yes No
Has your Student been suspended or expelled from school? *

Yes No
I confirm my Student's application for a 2022-23 class place at New School High.
Date

Month Day Year
Date
Parent / Guardian Signature *

Clear
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