Student Information

Student's First Name*

Student's Last Name*

Date of Birth*

Gender*

MaleFemale

Street Address*

City*

State*
Zip*

School District (or New York City Community School District), if known:

Grade Applying For

K12345
Current School

What language is primarily spoken in the student’s home or residence?

What was the first language your child learned?

Does your child have an Individualized Education Program (IEP)? YesNo

Parent/Guardian Information

First*

Last*

Relationship to Student*:

---Mother/Stepmother & Father/StepfatherMother/Stepmother OnlyFather/Stepfather OnlyLegal Guardian(s)

Home Address

City

State

Zip

Email*

Home* Phone Number, if available

Mobile Phone Number, if available

Work Phone Number, if available

Does the applicant have a sibling(s) who is currently enrolled in Brighter Choice Charter School for Boys or Brighter Choice Charter School for Boys?

Name

Date of Birth

Grade

MaleFemaleN/A

Name

Date of Birth

Grade

MaleFemaleN/A

Does the applicant have a sibling(s) who is applying to attend Brighter Choice Charter School for Boys or Brighter Choice Charter School for Girls?

Name

Date of Birth

Grade

MaleFemaleN/A

Name

Date of Birth

Grade

MaleFemaleN/A

I learned about Brighter Choice Charter School from the following:
---FriendRelativePostcardBus Shelter AdDaycare or Head Start ProgramWebsiteOther

Parent/Guardian Signature

Name*:
Date*:

I hereby testify that the information provided on this BCCS admission application is accurate and current.

Important Information Regarding Admission: Completion of this form demonstrates your desire to enroll your child at the Brighter Choice Charter Schools. Upon admission, families of Brighter Choice students must provide two proofs of current residency, parent/guardian picture ID, a copy of the student’s prior year academic record, birth certificate, and immunization record. A Student Registration Packet must also be completed.

Nondiscrimination Statement The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

Thank you for your interest in Brighter Choice Charter Schools!