PS/MS278 APPLICATION FORM GRADES 1-5

PS/MS278 APPLICATION FORM GRADES 1-5
Once you submit your application and your child has been accepted to PS/MS278, Ms. Gonzalez, Parent Coordinator, will contact you to make an appointment.

Please make sure to also email the following to agonzalez32@schools.nyc.gov: A copy of your child’s most current report card, Individualized Education Program (IEP) and/or 504 Accommodation Plan (if applicable)
STUDENT INFORMATION
Student's Full Name:

First NameMiddle NameLast Name
Student's Birthday ( Month/Date/Year)
example@example.com
Student Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Current 2024-2025 School Year
Student has the following:

Individualized Education Plan (IEP)504 Accommodation PlanNot applicable
Does the applicant have siblings who will attends this school?

YesNo
If yes, please enter the information for each sibling below:

Sibling 1: First NameSibling 1: Middle NameSibling 1: Last Name
Sibling 1's Birthday ( Month/Date/Year)
example@example.com
Sibling's Grade September 2024:
PARENT/GUARDIAN INFORMATION
Parent/Guardian's Full Name:

First NameLast Name
Contact Number (Daytime)
Please enter a valid phone number.
Contact Number (Cellphone)
Please enter a valid phone number.
Email
example@example.com
Any additional questions or concerns?
Signature

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STUDENT INFORMATION