Hanson Place SDA Elementary School
38 Lafayette Avenue
Brooklyn, NY 11217
Tel.: (718) 625-3030    Fax.: (718) 625-1727

Application for New Student

 

Student Information
Last Name First Name MI
Street/Ave City State ZIP
Birthplace Citizen of..

Parent/Guardian Information
Mother's Maiden Name SSN
Street/Ave City State ZIP
Home Phone Work Phone
Employer Position
Street/Ave City State ZIP
Father's Name SSN
Street/Ave City State ZIP
Home Phone Work Phone
Employer Position
Street/Ave City State ZIP
Applying for Grade. # of siblings # brothers # sisters
Last School Attended Grade level attained
School Address

Church Affiliation
Church affiliation If SDA please indicate where membership is held
Pastor's Name
Church Address
Has Applicant ever been suspended/expelled from school? YES NO If Yes 
Explain
Does the Applicant have any problems that may affect performance in class? YES NO If Yes
Explain

Emergency Contact Information
Emergency Contact other than Above Information Last
Name
First
Name		 MI
Phone #1 Relation to Parent
Phone #2

Certification
I have completed the above and it is true and accurate. I further pledge and promise that upon acceptance of my child to the Hanson Place S.D.A School, that I will cooperate with, and abide by the policies of the school and to pay the fees, dues, tuition, and applicable fees charged to the above applicant's account as stipulated. In understanding of above, I now affix my signature. (If you send this form by e-mail, you must sign at the school office at the earliest opportunity).

Signature:  Date: 

Do not type below this line
Tuition Category _________________ Book Fee Paid ____
Admission Personnel ________________________ Date _____________________________

Author information goes here.
Copyright © 1999 [Hanson Place SDA School]. All rights reserved.
Revised: July 30, 2008