PS/MS278 APPLICATION FORM GRADES 1-5

PS/MS278 APPLICATION FORM GRADES 1-5
Please fill out one application per student.

Once you submit your application and your student 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
The grade the student currently is in right now:*
Current school (School Name and Location, Eg: PSMS278 New York, New York):*
The grade the student will be in next year:*
When are you interested in enrolling your child? *
Student has the following:*

Individualized Education Plan (IEP)504 Accommodation PlanNot applicableOther
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's current grade this school year:
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
Should be Empty:

PS/MS278 APPLICATION FORM GRADES 1-5

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION