Enrollment_Nonpublic Textbook Request Form

Individual Student Request Form for Loan of Textbooks

This form must be completed for each student attending SRHS during the 26-27 school year. Review the paragraph below and then click the Next button to complete the form.
The New Jersey Nonpublic School Textbook Law (N.J.S.A. 18A:58-37.1et seq.) requires the board of education in each public school district in New Jersey with state funds to purchase and loan textbooks, upon individual request, to all students attending a nonpublic school located in the public school district. In order to be eligible, students must be enrolled full-time in kindergarten through grade twelve in a nonpublic school in New Jersey which complies with compulsory school attendance requirements and with the requirements of Title VI of the Civil Rights Act of 1964.

Click the next button below to complete the form.
Yes, my son/daughter is currently attending SRHSNo, I am registering my son/daughter for SRHS
- Textbooks include but are not limited to:
  - computer software;
  - computer-assisted instruction;
  - interactive videodiscs; and
  - other computer courseware and magnetic media.
  The following materials are not considered textbooks and are excluded:
  - Reference materials - encyclopedias, almanacs, atlases and general/special purpose dictionaries, of which the student does not have individual use;
  - Supplementary materials - supplementary books, magazines newspapers and audiovisual materials normally housed in the school library; and
  - Other materials - tests and testing materials, teachers' editions of textbooksand review books, computers (hardware), computer software materials such as blank disks or tapes or cassettes, computer chips, consoles (hardware), computer correction devices and cassette recorders.
  Statute and Code
  Nonpublic School Textbook Program: N.J.S.A. 18A:58-37.1 et seq.
  Nonpublic School Textbook Program Code: N.J.A.C. 6A:23A-20.1 et seq.
- Date*
  
  MonthDayYear
  Date

Public School Information
Public School District
Public School District Street Address*
Public School District City*
Public School District State*
Public School District Zip*
5 digit zip code only

Nonpublic School Information
Nonpublic School*
Street Address
City
State
Zip Code

Student Information
Name of Student*
Full name
Grade*
Student's Grade for the 2026-2027 school year
Name of Parent/Guardian*
Full name of Primary Guardian/Parent
Parent Email*
example@example.com

Parent/Guardian Certification
Public School District
Nonpublic School
Under the provisions of N.J.S.A. 18A: 58-37.1 et seq., I, {nameOf20}, hereby request Belmar School District to loan textbooks to St. Rose High School in which my child, {nameOf} is enrolled for grade {grade31}.

I certify that {nameOf} and I are residents of the State of New Jersey. I understand that the Belmar Public School District in which St. Rose High School is located has oversight of the State funds designated for providing the loan of textbooks to nonpublic school students pursuant to law and regulations.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Individual Student Request Form for Loan of Textbooks

Public School Information

Nonpublic School Information

Student Information

Parent/Guardian Certification